Second Quarter 2025 HCPCS Updates for Texas Medicaid July

Date: July 10, 2025

Attention: Providers

Effective date: July 1, 2025

Call to action: The purpose of this communication is to inform providers that on July 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the second quarter 2025 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2025.

How this impacts providers:

Second Quarter 2025 HCPCS Added Procedure Codes

The CAD procedure codes listed in the table above will be added as Medicaid benefits as of the Centers for Medicare & Medicaid Services (CMS) effective date, July 1, 2025. Claims will deny until a rate is implemented, but affected claims will be reprocessed back to the CMS effective date. The procedure codes will be payable at the July 1, 2025, published rate until the Texas Health and Human Services Commission (HHSC) rate hearing is held as required by the Texas Administrative Code §355.201.

The Healthy Texas Women (HTW) Program will add the following procedure codes as HTW Plus benefits:

Effective July 1, 2025, the following procedure codes will be added as noncovered procedure codes for Texas Medicaid:

Additional Benefit Information

Age limitations will apply for the following procedure codes:

Procedure code J1326 will be restricted to the following diagnosis codes:

Procedure code J9276 will be restricted to diagnosis codes C221, C23, C240, C248, and C249.

Procedure codes Q5099 and Q5100 will be restricted to the following diagnosis codes:

The following injections, when used for the treatment of end-stage renal disease or acute kidney injury, will be included in the composite rate payment and will not be paid separately:

• Metoprolol tartrate (procedure code J0616)
• Calcium chloride (procedure code J0618)
• Vancomycin hydrochloride (procedure code J3373)

Second Quarter 2025 HCPCS Discontinued Procedure Codes

Effective July 1, 2025, CMS will discontinue the following procedure codes:

Discontinued procedure codes will not be reimbursed after June 30, 2025.

CMS will discontinue procedure code M0248 effective December 12, 2024.

Second Quarter 2025 HCPCS Revised Procedure Codes

The description of the following procedure codes will be revised:

Note: Procedure code C8005 will be effective for dates of service on or after April 1, 2025.

Second Quarter 2025 HCPCS Informational Procedure Codes

The following procedure codes will be added as informational only:

CMS will revise the descriptions of the following informational procedure codes:

Next step for Providers: Providers should share this information with their billing staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.