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Texas MedicaidMedicaid · Billing Codes · General · TXHigh impact

Fourth Quarter NCCI Updates Effective October 1, 2026

Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Sep 26, 2026

Summary

Effective October 1, 2026, TMHP will implement fourth quarter National Correct Coding Initiative (NCCI) updates for Texas Medicaid and the CSHCN Services Program. Billing teams must review the updated NCCI rules on the CMS Medicaid NCCI website to identify code pair edits, bundling rules, and coding relationships that may affect claim submissions.

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What to do

by Sep 30, 2026 · 5 steps
01Billing team must access the CMS Medicaid NCCI web page (link available on tmhp.com Rate and Code Updates – NCCI Updates page) to review all fourth quarter NCCI updates, identify any code pairs that affect your practice's common procedures, and determine which claims may be impacted by new bundling or coding relationship edits.
02Update billing software edit tables and claim scrubbing logic to reflect the new NCCI rules before the October 1, 2026 effective date.
03For Medicaid MCO claims, contact the specific MCO to confirm any variations from fee-for-service NCCI rules.
04Failure to implement NCCI updates will result in claim denials and rejections when codes violate the new edits.
05For questions, contact TMHP Contact Center at 800-925-9126 or TMHP-CSHCN Services Program at 800-568-2413.

Original notice

Fourth Quarter NCCI Updates Effective October 1, 2026
tmhp.com · Always check the source before changing claims.
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Related changes

See all Texas Medicaid changes →
Third Quarter NCCI Updates Effective July 1, 2026HighEffective Jul 1, 2026 · GeneralSecond Quarter NCCI Updates Effective April 1, 2026HighEffective Apr 1, 2026 · GeneralFirst Quarter NCCI Updates Effective January 1, 2026MediumEffective Jan 1, 2026 · GeneralBrowse every Texas Medicaid change in the policy list

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