Reimbursement Rate Changes and Updates for Certain Texas Medicaid Procedure Codes

Date: April 2, 2025

Attention: Providers

Effective for dates of service on or after January 1, 2025

Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after January 1, 2025, reimbursement rate changes and updates for the procedure codes that were presented at the public rate hearing on February 14, 2025, will be implemented.

The Texas Medicaid & Healthcare Partnership (TMHP) will reprocess any affected claims that are identified. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is completed.

The following topics were covered at the hearing:

2025 Healthcare Common Procedure Coding System (HCPCS) Review for the following:

• ESRD Procedure Code J0879
• TOS 1 Non-Drugs
• TOS 1 Drugs
• TOS 2-8
• TOS 4-I-T
• TOS 5- Clinical Diagnostic Laboratory Services
• TOS 6-I-T
• TOS 9-J-L

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: https://www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts.