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Texas MedicaidMedicaid · Billing Codes · Billing · TX · ENT (Ear, Nose & Throat)Medium impact

Limitations and Claim Filing Requirements for New Hearing Device Procedure Codes

Effective date
Apr 1, 2026
Identified
Mar 10, 2026

Summary

Texas Medicaid is implementing new limitations and claim filing requirements for hearing device procedure codes effective April 1, 2026. Key changes include removing modifier requirements for certain codes, implementing frequency limitations, establishing add-on procedure requirements, and age-based restrictions for some services.

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What to do

Action · 6 steps
01Before April 1, 2026: Billing team must update system rules to remove modifier requirements for codes 92628, 92631, and 92634.
02Configure add-on procedure validations requiring primary codes for 92629, 92632, 92635, 92637, 92638, and 92639.
03Implement frequency limits: one hearing aid fitting per 5-year rolling period, two post-fitting follow-ups per calendar year.
04Add age-based restrictions for codes 92639 and 92641 (bilateral services only for patients 20 and under).
05Update encounter forms to reflect new same-day service denials.
06Claims submitted before April 1, 2026 will be automatically reprocessed by TMHP.

Codes mentioned

92628926299263192632926349263592636926379263892639926419264292622926239262692627V5010V5011

Original notice

Limitations and Claim Filing Requirements for New Hearing Device Procedure Codes
tmhp.com · Always check the source before changing claims.
View original ↗

Related changes

See all Texas Medicaid changes →
September 2026 TMPPM Update for Hearing Aid ServicesHighEffective Sep 1, 2026 · GeneralHearing Aid Procedure Codes 92628 and 92631 to Be UpdatedHighEffective Sep 1, 2026 · GeneralBrowse every Texas Medicaid change in the policy list

Related policy hubs

Texas Medicaid policiesTX policy changesENT (Ear, Nose & Throat)Code 92628Code 92629Code 92631Code 92632Code 92634Code 92635Code 92636Code 92637Code 92638Code 92639Code 92641Code 92642Code 92622Code 92623Code 92626Code 92627Code V5010Code V5011

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