Date: November 3, 2026
Attention: Providers
Effective: Dates of service on or after December 1, 2026
Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after December 1, 2026, Texas Medicaid benefits for peer specialist services will be updated to extend the age of eligibility for these services from 21 years of age and over to include 14 years of age and over. Benefit language for peer specialist services will also be updated to clarify coverage for telehealth delivery.
How this impacts providers: Certified Peer Specialists use their lived experience of recovery from a mental health or substance use condition to provide non-clinical and strength-based support to others who are experiencing similar challenges. Peer specialists support the person in:
- Achieving goals and objectives of the person-centered recovery plan
- Developing skills
- Problem solving
- Developing coping mechanisms
Extended Age Eligibility for Peer Specialist Services: Texas Medicaid will update the age eligibility for peer specialist services (procedure code H0038) from clients who are 21 years of age or older to clients who are 14 years of age or older.
Refer to Section 6, “Peer Specialist Services,” of the Texas Medicaid Provider Procedures Manual (TMPPM), Behavioral Health and Case Management Services Handbook for more information about peer specialist services.
Updated Telehealth Peer Specialist Services Benefit Information in the TMPPM: Peer specialist services may be delivered as a telehealth service. Providers must submit claims for telehealth peer specialist services as follows:
- Procedure code H0038 must be submitted with modifier 95 for services that are provided by synchronous audiovisual technology.
- Procedure code H0038 must be submitted with modifier FQ for services that are provided by synchronous telephone (audio-only) technology.
On December 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will update section 6.4.1, “Reimbursement,” of the TMPPM, Behavioral Health and Case Management Services Handbook to remove the following bulleted statement:
- “Must be delivered in person and not through advanced telecommunications technology”
Refer to Section 6.1.1, “Telehealth Service,” of the TMPPM, Behavioral Health and Case Management Services Handbookfor more information about telehealth peer specialist services.
Resources: Policy or Operational Documents:
Next step for Providers: Providers should share this communication with their staff.
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts.
