CORRECTION: Reimbursement Rate Updates for Certain HCPCS Procedure Codes Effective for Texas Medicaid Jan. 2026
Date: June 11, 2026
Attention: Providers
Effective date: January 1, 2026
UPDATE: This is a correction to the provider alert Texas Children’s Health Plan (TCHP) previously published on March 24, 2026. The Texas Medicaid & Healthcare Partnership (TMHP) has updated the affected spreadsheets in the list below to include the correct reimbursement information for the following spreadsheets.
- Radiology TOS 4-I-T
- Surgery and Assistant Surgery TOS 2-8
Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after January 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will implement reimbursement rate updates for certain Healthcare Common Procedure Coding System (HCPCS) procedure codes for Texas Medicaid. Corrected spreadsheets in the links below.
How this impacts providers: Providers can view the updates in the following spreadsheets:
- Ambulatory Surgical Center TOS F
- Clinical Diagnostic Laboratory Services TOS 5
- Dental TOS W
- Drugs TOS 1
- Durable Medical Equipment TOS 9-J-L
- Non-Drugs TOS 1
- Radiation Therapy TOS 6-I-T
- Radiology TOS 4 Non-Rural
- Radiology TOS 4 Rural
- Radiology TOS 4-I-T
- Surgery and Assistant Surgery TOS 2-8
Claims Reprocessing: 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.
Next step for Providers: Providers should share this information with their staff. 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, 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.