Reimbursement Rate Updates for Certain Drug Procedure Codes
Date: December 22, 2025
Attention: Providers
Effective for dates of service on or after October 1, 2025
Call to action: The Texas Medicaid & Healthcare Partnership (TMHP) has revised the reimbursement rates for some Healthcare Common Procedure Coding System (HCPCS) drug procedure codes that were updated during the third quarter of 2025.
How this impacts providers: Providers can view the updates in the following spreadsheets:
Next step for Providers: TMHP will identify and reprocess any claims that have been affected by this update. If there are any adjustments to claims reimbursement amounts, they will appear on future Remittance and Status (R&S) Reports.
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts.