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Texas MedicaidMedicaid · Billing Codes · Coding · TX · PediatricsHigh impact

Coming October 2026: Third Quarter HCPCS Updates to CSHCN Services Program Procedure Codes

Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
Aug 6, 2026

Summary

Effective October 1, 2026, Texas Medicaid will implement HCPCS procedure code updates for the CSHCN Services Program, including additions, revisions, and discontinuations. Discontinued codes will no longer be covered benefits. New codes will not be reimbursed until HHSC completes rate hearings and notifies providers of benefit changes.

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What to do

by Sep 15, 2026 · 5 steps
01Billing team must obtain the specific list of discontinued, added, and revised HCPCS codes from TMHP or the updated CSHCN Services Program Provider Manual and map them in the billing system.
02Before October 1, 2026: Remove discontinued codes from billing templates and disable them in billing software to prevent claims submission.
03Update claim scrubbing rules to reject any claims using deleted codes.
04Monitor for future HHSC notifications regarding new code reimbursement rates and benefit coverage.
05Contact TMHP-CSHCN Services Program Contact Center at 800-568-2413 for the complete code change list.
If missed: Failure to remove discontinued codes will result in claim denials.

Original notice

Coming October 2026: Third Quarter HCPCS Updates to CSHCN Services Program Procedure Codes
tmhp.com · Always check the source before changing claims.
View original ↗

Related changes

See all Texas Medicaid changes →
Reimbursement Rate Updates for Certain CSHCN HCPCS Drug Procedure Codes Effective July 1, 2026MediumEffective Jul 1, 2026 · PharmacyThird Quarter 2026 HCPCS Updates for the CSHCN Services ProgramMediumEffective Oct 1, 2026 · CodingReimbursement Rate Updates for Certain CSHCN HCPCS Drug Procedure Codes Effective April 1, 2026MediumEffective Apr 1, 2026 · PharmacyReimbursement Rate Updates for Certain CSHCN HCPCS Procedure Codes Effective September 1, 2026MediumEffective Sep 1, 2026 · CodingBrowse every Texas Medicaid change in the policy list

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