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Texas MedicaidMedicaid · Coverage · Policy · TX · Psychiatry, PediatricsMedium impact

Benefit Updates for Texas Medicaid Peer Specialist Services Effective December 1, 2026

Act
by Dec 1, 2026
Effective date
Dec 1, 2026
Identified
Oct 17, 2026

Summary

Texas Medicaid is expanding peer specialist services (H0038) eligibility from age 21+ to age 14+, effective December 1, 2026. Providers may now bill telehealth peer specialist services using modifier 95 (synchronous audiovisual) or modifier FQ (synchronous telephone), replacing the prior in-person-only requirement.

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What to do

by Dec 1, 2026 · 4 steps
01Billing team must update claims submission processes to (1) reflect expanded age eligibility for H0038 services starting at age 14 instead of age 21, and (2) correctly append modifier 95 for synchronous audiovisual telehealth peer specialist claims and modifier FQ for synchronous telephone-only peer specialist claims.
02Update billing system documentation and staff training to reflect removal of the in-person-only delivery requirement.
03Providers should contact the member's specific MCO for administrative procedure details (prior authorization, precertification, referrals).
04Current MCO-specific requirements may differ from this fee-for-service guidance.

Codes mentioned

H0038

Original notice

Benefit Updates for Texas Medicaid Peer Specialist Services Effective December 1, 2026
tmhp.com · Always check the source before changing claims.
View original ↗

Related changes

See all Texas Medicaid changes →
Updates to Prior Authorization for Services and Clinician-Administered Drug Benefits for HTW/HTW PlusMediumEffective Jul 1, 2026 · Prior AuthorizationBrowse every Texas Medicaid change in the policy list

Related policy hubs

Texas Medicaid policiesTX policy changesPsychiatryPediatricsCode H0038

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