Reimbursement Rate Changes and Updates for Certain Texas Medicaid Procedure Codes Effective for April and June

Date: April 4, 2025

Attention: Providers

Effective April 1, 2025, and June 1, 2025

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after April 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.

How this impacts providers:

The following topics were covered at the hearing:

Effective for Dates of Service on or After April 1, 2025

• Calendar fee review for Long-Acting Reversible Contraceptives (LARCS)
• Policy review for Q Codes — Wound Care Skin Substitute

Effective for Dates of Service on or After June 1, 2025

• Policy review for Wound Care Education

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, and 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 https://www.texaschildrenshealthplan.org/providers.

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.