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Third Quarter 2026 HCPCS Updates for Texas Medicaid
Effective date
Oct 1, 2026
Identified
Oct 2, 2026
Summary
Texas Medicaid's third quarter 2026 HCPCS update made new codes effective for dates of service on or after October 1, 2026, which is already in effect. Several added drug codes will be denied until a rate is implemented and then reprocessed back to October 1, while other added codes are pending a rate hearing, some codes are non-covered, and 18 codes were discontinued after September 30, 2026. Some codes carry prior authorization, age or diagnosis limits, so the billing team needs to update charge entry before claims go out.
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What to do
Action · 13 steps
01Already effective October 1, 2026 (check current applicability with TMHP before relying on this): Billing team: update the charge master and claim scrubber so the discontinued codes (0556U, 0557U, 0585U, C8010, C9046, C9310, C9462, J0640, J1941, J1953, J7514, J7517, J7519, J7528, J9181, J9190, J9352, L8696) are not used on dates of service on or after October 1, 2026.
02Claims for these codes will not be reimbursed after September 30, 2026.
03The notice lists J9352 as discontinued and J9362 as added, so confirm the replacement mapping in TMHP's article before billing trabectedin.
04Billing team: for the added drug codes (C9311, C9313, J0643, J0644, J0871, J1757, J1818, J1946, J1947, J1957, J1958, J3268, J3406, J7524, J7526, J7529, J7530, J9186, J9187, J9191, J9192, J9362 and Q5172), add them to charge entry with the age and diagnosis limits in the notice.
05Prior authorization: J3406 (omidubicel-only, Omisirge) now requires PA and replaces J3590 under TMPPM section 6.96.1; L1972 and A4228 also require PA under the DME handbook sections the notice cites; check the request for each before scheduling.
06Non-covered codes (C9312, J9066, Q5173, A2046 through A2050, A6614, A9613, E2403, G0685, J0014, L1330, Q4207, Q4223, Q4243): do not bill these to Texas Medicaid, and the notice does not describe patient billing, so check with TMHP before any member billing.
07Codes A2046, A2047, A2048, A2049, A2050, A9613, Q4207, Q4223 and Q4243 are not benefits because they are part of another service, so do not bill them separately.
08Pending rate hearing (87638, A4228, E0788, L1972, L8697 and the other added non-CAD codes): TMHP will notify providers in a future article if a rate changes or if claims will not be reimbursed.
09Code 87638 requires the CLIA certifications listed on tmhp.com for dates of service on or after May 15, 2026.
10Update the revised descriptions (A9595, C1982, C8004, C9797, J3300, J9033, L1971, L8030, L8031, L8035, S0169) in the fee and code lists.
11Informational codes (the 0600U to 0697U range, 0660U to 0698U, 1054T to 1111T and the other informational codes in the notice) are for reference only and do not change billing.
12HTW Plus members: J7531 is added as a benefit for the Healthy Texas Women program only.
13Managed care members: the notice says MCO prior authorization and claim rules may differ, so confirm with each MCO.
Codes mentioned
C9311C9313J0643J0644J0871J1757J1818J1946J1947J1957J1958J3268J3406J7524J7526J7529J7530J7531J9186J9187J9191J9192J9362Q517287638A4228E0788L1972L8697C9312J9066Q5173A2046A2047A2048A2049A2050A6614A9613E2403G0685J0014L1330Q4207Q4223Q4243C8010C9046C9310C9462J0640J1941J1953J7514J7517J7519J7528J9181J9190J9352L8696A9595C1982C8004C9797J3300J9033L1971L8030L8031L8035S0169J1749J3424J7176Q5161Q5168Q5169M0231M0232Q0234E85.1C86.4E76.1E72.21G20A1G20A2G20B1G20B2G20CI50.1I50.20I50.22I50.23I50.30I50.32I50.33I50.40I50.42I50.43I50.810I50.812I50.813I50.814I50.82I50.83I50.84I50.89I50.9
Original notice
Third Quarter 2026 HCPCS Updates for Texas Medicaid
tmhp.com · Always check the source before changing claims.
Related changes
See all Texas Medicaid changes →Third Quarter 2026 HCPCS Updates for the CSHCN Services ProgramMediumEffective Oct 1, 2026 · CodingFirst Quarter 2026 HCPCS Updates for Texas MedicaidHighEffective Apr 1, 2026 · CodingFirst Quarter 2026 HCPCS Updates for the CSHCN Services ProgramHighEffective Apr 1, 2026 · CodingNovember 2026 TMPPM Update for Colony Stimulating FactorsMediumEffective Nov 1, 2026 · GeneralBrowse every Texas Medicaid change in the policy list
Related policy hubs
Texas Medicaid policiesTX policy changesOncologyPharmacyPathologyHematologyTransplant SurgeryCode C9311Code C9313Code J0643Code J0644Code J0871Code J1757Code J1818Code J1946Code J1947Code J1957Code J1958Code J3268Code J3406Code J7524Code J7526Code J7529Code J7530Code J7531Code J9186Code J9187Code J9191Code J9192Code J9362Code Q5172Code 87638Code A4228Code E0788Code L1972Code L8697Code C9312Code J9066Code Q5173Code A2046Code A2047Code A2048Code A2049Code A2050Code A6614Code A9613Code E2403Code G0685Code J0014Code L1330Code Q4207Code Q4223Code Q4243Code C8010Code C9046Code C9310Code C9462Code J0640Code J1941Code J1953Code J7514Code J7517Code J7519Code J7528Code J9181Code J9190Code J9352Code L8696Code A9595Code C1982Code C8004Code C9797Code J3300Code J9033Code L1971Code L8030Code L8031Code L8035Code S0169Code J1749Code J3424Code J7176Code Q5161Code Q5168Code Q5169Code M0231Code M0232Code Q0234Code E85.1Code C86.4Code E76.1Code E72.21Code G20A1Code G20A2Code G20B1Code G20B2Code G20CCode I50.1Code I50.20Code I50.22Code I50.23Code I50.30Code I50.32Code I50.33Code I50.40Code I50.42Code I50.43Code I50.810Code I50.812Code I50.813Code I50.814Code I50.82Code I50.83Code I50.84Code I50.89Code I50.9