Date: December 24, 2025
Attention: Providers
Effective for dates of service on or after January 1, 2026
Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of the following.
The 2026 annual Healthcare Common Procedure Coding System (HCPCS) updates will be effective for dates of service on or after January 1, 2026, and will be presented at a rate hearing in March 2026.
A hearing will still occur in February 2026 to propose pricing for long-acting reversible contraceptives (LARCS) and other services.
Hearing dates will be posted on the Texas Health and Human Services Commission (HHSC) Meetings and Events website and published in the Texas Register.
Background information: On January 1, 2026, Texas Medicaid will apply the 2026 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions. Deleted procedure codes will no longer be benefits of Texas Medicaid. The 2026 HCPCS information will be available on tmhp.com on January 1, 2026.
Important to note: Texas Medicaid must approve expenditures before rates can be adopted. New benefits that are adopted by Texas Medicaid must undergo the rate hearing process to receive public comment on proposed reimbursement rates. For new benefits, an interim rate is typically set before the hearing to allow for claims processing.
The Texas Medicaid & Healthcare Partnership (TMHP) will publish the 2026 annual HCPCS information on tmhp.com as follows:
A website article will be published on Dec. 31, 2025, identifying the new and discontinued 2026 annual HCPCS procedure codes.
A special bulletin will be published by Feb. 1, 2026, with all benefit information that is related to the 2026 annual HCPCS updates.
How this impacts providers: Providers are expected to submit claims for the new 2026 HCPCS procedure codes beginning January 1, 2026. These claims must be submitted within the initial 95-day filing deadline. MCOs as TCHP must identify and reprocess any claims that have been affected without requiring the providers to resubmit claims or appeal the claims unless they were denied for other reasons after the claims reprocessing is complete.
Next step for Providers: Claims Submission for New Procedure Codes
Please note for fee-for-service (FFS), providers who bill TMHP directly for services that are provided before expenditures are approved will be denied with explanation of benefits (EOB) 02008, “This procedure code has been approved as a benefit pending the approval of expenditures. Providers will be notified of the effective dates of service in a future notification if expenditures are approved.” If expenditures are not approved for a particular procedure code, that procedure code will not be made a benefit effective January 1, 2026.
After Texas Medicaid approves expenditures, for FFS claims, TMHP will identify and reprocess any claims that have been affected. For FFS, providers do not need to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete. If there are any adjustments to claim reimbursement amounts, they will appear on future Remittance and Status (R&S) Reports.
If the effective date changes for a new procedure code, then TMHP will publish information in a future article on their website. Clients cannot be billed for services that are provided outside of the procedure code effective date.
To avoid submitting fraudulent claims, providers are always expected to submit claims with the procedure codes that are most appropriate for the services that are provided.
Providers should also follow the guidance provided in this communication and found on tmhp.com.
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts.
