MedicaidBilling CodesMedium impact
Coming October 2026: Third Quarter HCPCS Updates to Texas Medicaid Procedure Codes
Texas Medicaid·TX·Coding
Effective date
Oct 1, 2026
We identified it
Aug 6, 2026
Summary
Effective October 1, 2026, Texas Medicaid will implement HCPCS procedure code updates (additions, revisions, and discontinuations) from CMS. Discontinued codes will no longer be covered; added codes require HHSC rate hearing approval before reimbursement begins, though clinician-administered drug codes may be reprocessed back to the CMS effective date once rates are implemented. Billing teams must monitor for code changes and coordinate with MCOs regarding administrative procedures.
Action Required
By September 30, 2026: Billing team must (1) Access the Texas Medicaid Provider Procedures Manual and CMS HCPCS Q3 2026 updates to identify specific codes being added, revised, or discontinued; (2) Update billing system to discontinue processing claims for any removed procedure codes effective October 1, 2026; (3) Configure system to hold newly added codes as non-reimbursable until HHSC publishes the rate hearing results and rates are implemented; (4) For clinician-administered drug codes approved as benefits, prepare claims for retroactive reprocessing back to October 1, 2026 once rates are announced; (5) Contact each member's MCO to clarify prior authorization, precertification, and referral requirements for the new codes, as procedures may differ from fee-for-service Medicaid and between MCOs. Monitor TMHP communications (800-925-9126) for rate hearing notifications. Failure to discontinue billing for removed codes will result in claim denials; new codes billed before rate implementation will be denied until reprocessed.