Quarterly Reimbursement Rate Updates for Some HCPCS Drug Procedure Codes

Date: June 24, 2025

Attention: All Providers

Subject: Quarterly Reimbursement Rate Updates for Some HCPCS Drug Procedure Codes

Effective date: April 1, 2025

Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after April 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) changed the reimbursement rates for some Healthcare Common Procedure Coding System (HCPCS) drug procedure codes that were updated during the first quarter of 2025.

TMHP will identify and reprocess any affected claims. Providers do not need to appeal these claims unless TMHP denies them for additional reasons after reprocessing is completed.

To view the updates, access the Drug Procedure Codes spreadsheet.

Next steps: 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,log into:
www.texaschildrenshealthplan.org/provideralerts.