UPDATED Reimbursement Rate Changes and Updates for Certain Texas Medicaid Procedure Codes for March 2026

Date: February 12, 2026

Attention: Providers

Effective date: March 1, 2026

Update as of March 12, 2026:Per Texas Medicaid & Healthcare Partnership (TMHP), the original article featured incorrect information in the Hearing Aids, Male Genital System Surgery, Musculoskeletal System Surgery, and Radiology TOS 4-I-T Rural Hospitals spreadsheets. The affected spreadsheets have been updated and now feature the correct reimbursement information.

Call to action: The Texas Medicaid & Healthcare Partnership (TMHP) has revised the reimbursement rates for changes and updates for the procedure codes that were presented at the public rate hearing on November 10, 2025.

Next step for Providers: The following topics were covered at the November 10, 2025, public rate hearing.

Calendar Fee Review for the following:

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

Second Quarter 2025 HCPCS Review for the following:

Medical Policy

Office Setting Skin Substitute

Texas Medicaid managed care organizations (MCOs) like Texas Children’s Health Plan (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 at https://www.texaschildrenshealthplan.org/providers.

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

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