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:
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:
www.texaschildrenshealthplan.org/provideralerts.