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Reimbursement Rate Changes and Updates for Certain Texas Medicaid Procedure Codes July 2025
Date: July 28, 2025
Attention: Providers
Subject: Reimbursement Rate Changes and Updates for Certain Texas Medicaid Procedure Codes July 2025
Effective date: September 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 September 1, 2025, 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 27, 2025.
How this impacts providers: The following topics were covered at the hearing.
- Cardiovascular Services, including Cardiography & Echocardiography - Acute Care
- Cardiovascular Services, including Cardiography & Echocardiography - Hospital
- Cardiovascular Services, including Cardiography & Echocardiography - Rural Hospital
- Dialysis
- Dialysis Services L-E1629
- Gastroenterology - Acute Care
- Gastroenterology - Hospital
- Gastroenterology - Rural Hospitals
- Medicine (Other)
- Non-Clinical Labs - Acute Care
- Non-Clinical Labs - Hospital
- Non-Clinical Labs - Rural Hospital
- Non-Invasive Vascular Diagnostics - Acute Care
- Non-Invasive Vascular Diagnostics - Hospital
- Non-Invasive Vascular Diagnostics - Rural Hospital
- Physician Administered Drugs - Non-Oncology
- Physician Administered Drugs - Oncology
- Physician Administered Drugs - Vaccines & Toxoids
- Physician Administered Drugs - NDCX
- S Codes TOS 1-2-8
- S Codes TOS 9-J-E
- Telehealth, Telemonitoring, & Telemedicine
- TOS 1-2-I-T
Third Quarter 2025 Healthcare Common Procedure Coding System (HCPCS) Review for the following:
Fourth Quarter 2025 Healthcare Common Procedure Coding System (HCPCS) Review for the following:
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: www.texaschildrenshealthplan.org/provideralerts.