MedicaidReimbursementMedium impact
Reimbursement Rate Updates for Certain CSHCN HCPCS Procedure Codes Effective September 1, 2026
Texas Medicaid·TX · Pediatrics·Coding
Effective date
Sep 1, 2026
We identified it
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.
Action Required
Before 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. Update all billing system fee schedules and rate tables to reflect the new reimbursement amounts for CSHCN program claims. Verify that all HCPCS codes billed on or after September 1, 2026 use the updated rates. Contact TMHP at 800-925-9126 if specific code information or clarification is needed. Failure to update rates may result in underbilling or claim denials.