MedicaidBilling CodesHigh impact
Hearing Aid Procedure Codes 92628 and 92631 to Be Updated
Texas Medicaid·TX · Audiology, ENT (Ear, Nose & Throat)·General
Effective date
Sep 1, 2026
We identified it
Jul 28, 2026
Summary
Effective September 1, 2026, Texas Medicaid (TMHP) is removing bundling restrictions that previously prohibited billing hearing aid procedure codes 92628 and 92631 on the same day as other hearing aid codes. Billing teams can now submit claims with these codes billed together with specified companion codes (92628 with 92631/92632, and 92631 with 92628/92629). This change requires immediate updates to billing system edits and claim submission protocols to avoid unnecessary denials.
Action Required
By August 31, 2026: Billing team must update billing system software to remove bundle/same-day restrictions between CPT 92628, 92631, 92632, and 92629 for Texas Medicaid (TMHP) claims. Specifically: allow 92628 to bill on same day as 92631 and 92632; allow 92631 to bill on same day as 92628 and 92629. Update claim scrubbers and edit rules in billing software to permit these code combinations. Providers should contact their specific Texas Medicaid MCO if enrolled in managed care to confirm MCO-specific billing procedures. Failure to update system edits will result in claim denials for valid same-day hearing aid procedure combinations on or after September 1, 2026.