MedicaidReimbursementHigh impact
Reimbursement Rate Changes and Updates for Certain Texas Medicaid Procedure Codes Effective September 1, 2026
Texas Medicaid·TX · Cardiology, Cardiothoracic Surgery, Gastroenterology +7 more·Fee Schedule
Effective date
Sep 1, 2026
We identified it
Sep 1, 2026
Summary
Texas Medicaid (TMHP) is implementing reimbursement rate changes and fee schedule updates effective September 1, 2026, across multiple procedure code categories including cardiovascular and digestive system surgeries, G codes, HCPCS codes, medical transportation, and other services. Specific reimbursement rates will be based on updates from the May 26, 2026 public rate hearing and Q3/Q4 2026 HCPCS reviews. The billing team must verify updated rates in the TMHP system and adjust claims processing accordingly.
Action Required
By August 31, 2026: Billing team must obtain the detailed fee schedule from TMHP Contact Center (800-925-9126) containing specific reimbursement rates for all affected code categories (cardiovascular system surgery, digestive system surgery, G codes, R codes, T codes, urinary system surgery, respiratory system surgery, vision devices, HCPCS drugs, durable medical equipment, physician-administered drugs/vaccines, and dental services). Update billing software with new rates before September 1, 2026. Verify that all claims submitted on or after September 1, 2026 reflect the updated reimbursement rates. Contact each MCO separately if the practice contracts with managed care organizations, as administrative procedures and rates may differ from fee-for-service Medicaid. Failure to apply correct rates will result in claim payment discrepancies or denials.