Flu Season Alert!Alerta de temporada de influenza:
Don’t let germs win this season – protect yourself and your family!
The flu vaccine is your best defense against flu and related complications – PLUS, it is a covered benefit for Texas Children’s Health Plan members! Learn more!
¡No permitas que los gérmenes ganen esta temporada! ¡Protégete a ti y a tu familia!
La vacuna contra la influenza es tu mejor defensa contra la influenza y sus complicaciones. Además, ¡es un beneficio cubierto para los miembros de Texas Children's Health Plan! Aprende más
Reimbursement Rate Updates for Certain HCPCS Drug Procedure Codes
Date: July 7, 2025
Attention: All Providers
Effective date: September 20, 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) will change the reimbursement rates for certain Healthcare Common Procedure Coding System (HCPCS) drug procedure codes that were updated during the first quarter of 2025. These rate updates will be implemented for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.
TMHP will reprocess any affected claims that are identified. Providers can appeal the claims if TMHP denies them for additional reasons after reprocessing is completed.
Please note: Prior authorization will be required for the affected HCPCS drug procedure codes as part of this update.
To view the updates, access the following spreadsheets:
