Reimbursement Rate Changes and Updates for Certain Texas Medicaid Procedure Codes
Date: September 9, 2026
Attention: Providers
Effective date: September 1, 2026
Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the reimbursement rate changes and updates for the procedure codes that were presented at the public rate hearing on May 26, 2026.
How this impacts providers: The following topics were covered at the hearing:
- Calendar Fee Review for the following:
- Cardiovascular System Surgery
- Digestive System Surgery
- G Codes Acute Care
- G Codes Hospital
- G Codes Rural Hospital
- Medical Transportation Program (MTP)—Non-Emergency Transportation (NEMT)
- Physician Administered Drugs Vaccines and Toxoids
- R Codes
- Proton Therapy
- Respiratory System Surgery
- T Codes
- Urinary System Surgery
- Vision Devices
- Third Quarter 2026 Healthcare Common Procedure Coding System (HCPCS) Review for the following:
- Fourth Quarter 2026 HCPCS Review for the following:
- Special Review
Next step for Providers: Providers should share this communication with their staff.
Texas Medicaid managed care organizations (MCOs) like TCHP must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO/TCHP. Administrative procedures, such as prior authorization, precertification, referrals, claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should reference a member’s specific MCO/TCHP for information on these items. For TCHP, this information can be found on the provider page available here texaschildrenshealthplan.org/providers.
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts.