MedicaidBilling CodesHigh impact
September 2026 TMPPM Update for Hearing Aid Services
Texas Medicaid·TX · Audiology, ENT (Ear, Nose & Throat)·General
Effective date
Sep 1, 2026
We identified it
Aug 5, 2026
Summary
Effective September 1, 2026, TMHP is updating hearing aid services billing rules to deny claims for procedure codes 92628 and 92631 when submitted on the same date of service for the same ear as specific conflicting procedure codes. This creates new claim denial triggers that billing staff must monitor to avoid rejected claims.
Action Required
By September 1, 2026: Billing team must implement system edits to prevent claims submission errors and flag potential denials. (1) Update billing software to add automated denial rules: deny CPT 92628 when billed on same DOS/same ear as CPT 92622, 92623, 92626, 92627, 92634, 92635, 92636, 92637, or HCPCS V5010; deny CPT 92631 when billed on same DOS/same ear as CPT 92622, 92623, 92626, 92627, 92636, or 92637. (2) Create provider alerts/education noting these code combinations are mutually exclusive per ear on the same date. (3) Update encounter forms or claim submission checklists to remind audiology providers to verify they are not billing conflicting codes on the same ear. (4) Configure system to route any claims triggering these combinations to manual review before submission. (5) For MCO-contracted services, contact individual MCOs to verify they have adopted these same limitations, as MCO administrative procedures may vary. Failure to implement these edits will result in automatic claim denials from TMHP.