MedicaidReimbursementHigh impact
Correction to “Reimbursement Rate Updates for Certain CSHCN Procedure Codes Effective July 1, 2026”
Texas Medicaid·TX · ENT (Ear, Nose & Throat), General Surgery, Pathology·Fee Schedule
Effective date
Jul 1, 2026
We identified it
Jul 3, 2026
Summary
TMHP has issued a correction to the July 1, 2026 CSHCN reimbursement rate updates, fixing incorrect information in the Clinical Laboratory Services spreadsheet. Billing teams must immediately download and implement the corrected reimbursement rates for Clinical Laboratory Services, Ear, Nose, and Throat, and Female Genital System Surgery procedure codes to avoid claim denials starting July 1, 2026.
Action Required
Immediately: Billing team must download the corrected spreadsheets from TMHP for Clinical Laboratory Services, Ear, Nose, and Throat, and Female Genital System Surgery. Update billing software fee schedules and rate tables to reflect corrected reimbursement rates before July 1, 2026. Verify that all claims processed on or after July 1, 2026 use the corrected rates. Contact TMHP-CSHCN Services Program Contact Center at 800-568-2413 if clarification is needed on specific code updates. Failure to implement corrected rates will result in claim denials and payment discrepancies for CSHCN procedures.