First Quarter 2026 HCPCS Updates for Texas Medicaid
AI Summary
Texas Medicaid is implementing first quarter 2026 HCPCS updates effective April 1, 2026, adding new covered and non-covered procedure codes with specific age limitations and prior authorization requirements. Several existing codes are being discontinued with direct replacements required.
Action Required
By April 1, 2026: Billing team must update system to add new covered and non-covered procedure codes, implement age restrictions for specific codes (18+ for C9818, J1164, J3404, J8502, J9183, J9278, J9601; 12+ for J9277; birth-20 for L2221), configure prior authorization requirements for C8007, C8011, J3404, and L2221, replace discontinued codes C9145 with J8502, C9307 with J9601, and C9308 with J9278, and restrict J9601 to diagnosis codes C9000 and C9002. Update encounter forms and train staff on new requirements. Claims will be denied for discontinued codes after March 31, 2026.
Affected Billing Codes
Plan Types
Medicaid
States
TX
Specialties
oncology, wound-care, orthopedics, all-specialties