MedicaidReimbursementMedium impact
Reimbursement Rate Updates for Certain HCPCS Procedure Codes Effective January 1, 2026, for Texas Medicaid
Texas Medicaid·TX·Billing
Effective date
Jan 1, 2026
We identified it
Mar 20, 2026
Summary
Texas Medicaid is implementing reimbursement rate updates for certain HCPCS procedure codes effective January 1, 2026, affecting multiple service categories including surgery, radiology, dental, DME, and laboratory services. TMHP will automatically reprocess affected claims and adjustments will appear on future Remittance and Status Reports.
Action Required
Before January 1, 2026: Billing team should review the TMHP spreadsheets for specific rate changes in applicable service categories (Surgery TOS 2-8, Radiology TOS 4, Dental TOS W, DME TOS 9-J-L, Lab TOS 5, etc.). Monitor future R&S Reports for automatic claim reprocessing adjustments. Contact TMHP at 800-925-9126 for questions about specific rate changes.