Important Update Actualización importante:

Good news! All CHIP, STAR, and STAR Kids Member Handbooks are now available online. Quick, easy access to your benefits and coverage information - any time!

¡Buenas noticias! Todos los manuales para miembros de CHIP, STAR y STAR Kids ya están disponibles en línea. Obtén acceso rápido y sencillo a la información sobre tus beneficios y cobertura, ¡en cualquier momento!

Medicaid Preferred Drug List and Formulary Changes Cambios en el formulario y la lista de medicamentos preferidos de Medicaid

The Vendor Drug Program (VDP) made changes to the Texas Medicaid drug formulary effective July 24, 2026. To learn more about formulary changes impacted, please click here for more information.

El programa de medicamentos de proveedores de Texas (VDP) ha realizado cambios recientes en el formulario de medicamentos de Medicaid de Texas. Esto entrará en vigencia el 24 de julio de 2026. Para obtener más información sobre los cambios en el formulario afectados, visite el siguiente enlace para obtener más información.

Search

HCPCS Annual Updates for 2026

Call to action: The purpose of this communication is to inform providers that on January 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) applied the 2026 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations.

2026 HCPCS Procedure Code Additions

How this impacts providers: Important details about the updates are as follows.

  • Benefit changes related to the 2026 annual HCPCS updates will be published in a special bulletin by February 1, 2026.
  • Discontinued procedure codes will no longer be benefits of Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program.
  • The presence of “Requires rate hearing” or “Requires rate review” in the 2026 HCPCS Procedure Code Additions table indicates a new procedure code that is pending a rate hearing and approval of expenditures.
  • Providers will be notified in a future article if a new procedure code is not approved for reimbursement.

Providers may refer to the following resources for more information about the public rate hearings and approval of expenditure:

Next step for Providers: Providers should share this communication with their staff. 
Important: To avoid submitting fraudulent claims, providers must submit claims with the procedure codes that are most appropriate for the services that are provided.

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org. 

For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts.