MedicaidCoverageMedium impact
September 2026 TMPPM Update for Solid Organ Transplants
Texas Medicaid·TX · Transplant Surgery, Pediatrics·General
Effective date
Sep 1, 2026
We identified it
Jul 18, 2026
Summary
Effective September 1, 2026, TMHP is removing the reference to thymus transplant from section 9.2.51 of the TMPPM. However, thymus transplant remains covered by Texas Medicaid for medically necessary cases in children ages birth through 20 years via EPSDT coverage. Billing teams must understand that while the manual reference is being removed, the procedure is still a covered 1905(a) service and claims should not be denied based on the manual update alone.
Action Required
Before September 1, 2026: Billing team must review internal documentation and billing system notes that reference section 9.2.51 of the TMPPM regarding organ/tissue transplants. Do NOT treat the removal of thymus transplant from the manual section as a coverage denial. For any thymus transplant claims for Texas Medicaid members ages birth through 20 years: (1) Continue to process claims as medically necessary EPSDT/1905(a) services; (2) Ensure claims include appropriate documentation of medical necessity and member age eligibility; (3) Contact the specific MCO for the member to confirm prior authorization and administrative procedures, as these may vary by plan; (4) If claims are denied, appeal citing continued EPSDT/1905(a) coverage availability. Update billing staff training to clarify that manual section deletions do not automatically eliminate coverage for medically necessary services. Contact TMHP at 800-925-9126 with questions about specific claim scenarios.