First Quarter 2026 HCPCS Updates for the CSHCN Services Program
AI Summary
Texas Medicaid CSHCN Services Program is implementing Q1 2026 HCPCS updates effective April 1, 2026. Multiple codes are being added as benefits (pending rate hearings), added as non-covered, or discontinued entirely. Several new codes require prior authorization and have age restrictions.
Action Required
By April 1, 2026: Billing team must update system to add prior authorization requirements for codes A6548, C8007, and C8011. Implement age restrictions for C9818, J1164, J8502 (18+ years) and Q5162 (12+ years). Stop billing discontinued codes C9145, C9307, C9308, L6000, L6010, L6020 after March 31, 2026. Mark non-covered codes as non-billable in system. Claims will be denied without proper prior auth or for discontinued codes after cutoff date.
Affected Billing Codes
Plan Types
Medicaid
States
TX
Specialties
all-specialties