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Texas MedicaidMedicaid · Reimbursement · Coding · TX · PediatricsMedium impact

Reimbursement Rate Updates for Certain CSHCN HCPCS Procedure Codes Effective September 1, 2026

Effective date
Sep 1, 2026
Identified
Aug 7, 2026

Summary

Effective September 1, 2026, Texas Medicaid & Healthcare Partnership (TMHP) is implementing reimbursement rate updates for specific HCPCS procedure codes used in the Children with Special Health Care Needs (CSHCN) Services Program. Billing teams must obtain and review the updated fee schedules from TMHP to ensure accurate reimbursement for affected codes.

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What to do

Action · 4 steps
01Before September 1, 2026: Billing team must access and download the updated HCPCS reimbursement rate spreadsheets from TMHP (Non-Drugs TOS 9-J-L and Vaccines categories) at https://www.tmhp.com/news/2026-08-06-reimbursement-rate-updates-certain-cshcn-hcpcs-procedure-codes-effective-september.
02Update all billing system fee schedules and rate tables to reflect the new reimbursement amounts for CSHCN program claims.
03Verify that all HCPCS codes billed on or after September 1, 2026 use the updated rates.
04Contact TMHP at 800-925-9126 if specific code information or clarification is needed.
If missed: Failure to update rates may result in underbilling or claim denials.

Original notice

Reimbursement Rate Updates for Certain CSHCN HCPCS Procedure Codes Effective September 1, 2026
tmhp.com · Always check the source before changing claims.
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