Texas Medicaid to Implement Updated ICD-10-PCS Procedure Codes

Effective April 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will apply surgical procedure code additions, deletions, and revisions tied to the 2026 updates for the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). These ICD-10-PCS codes are used for inpatient hospital procedures and should be submitted only on inpatient hospital claims, when applicable.

For professional services and outpatient procedures, providers should continue using the American Medical Association Current Procedural Terminology manual and the Centers for Medicare & Medicaid Services Healthcare Common Procedure Coding System manual.

When reviewing ICD-10-PCS procedure codes, providers should check the official code set from the appropriate copyright holder for full descriptions of all newly added, discontinued, and revised codes. Texas Medicaid will no longer reimburse discontinued procedure codes for dates of service on or after April 1, 2026.

These surgical procedure codes are used to support proper diagnosis-related group assignment for an inpatient hospital stay. They are processed for informational purposes only.

Providers who need more information may contact the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.

TMHP also reminds providers that Texas Medicaid managed care organizations are responsible for covering all medically necessary Medicaid services for enrolled members. Even so, administrative requirements such as prior authorization, precertification, referrals, claims filing, and encounter data submission may differ from traditional fee-for-service Medicaid and may also vary between managed care organizations. Providers should check directly with the member’s specific MCO for plan-level requirements.