Third Quarter HCPCS Updates to Texas Medicaid Procedure Codes October 2025

Date: August 26, 2025

Attention: Providers

Effective date: October 1, 2025

Call to action: The purpose for this communication is to inform providers that the Texas Medicaid & Healthcare Partnership (TMHP) will implement procedure code additions, revisions, and discontinuations based on updates that were made to the Healthcare Common Procedure Coding System (HCPCS) by the Centers for Medicare & Medicaid Services (CMS) for the third quarter of 2025. The updates will be effective for dates of service on or after October 1, 2025.

How this impacts providers:

• Discontinued procedure codes will no longer be benefits of Texas Medicaid.
• Added procedure codes will not be reimbursed until the Texas Health and Human Services Commission (HHSC) reviews the codes and holds a rate hearing. Providers will be notified of any benefit changes in a future article. Providers can refer to the Texas Medicaid Provider Procedures Manual for current benefit information.
• Reminder: For clinician-administered drug procedure codes that are included in a quarterly HCPCS update and approved to be added as Medicaid benefits by HHSC, the rate may be effective as of the CMS effective date. Texas Medicaid will deny claims until the rate has been implemented, but TMHP will reprocess affected claims back to the CMS effective date. The procedure codes will be reimbursable at the published rate until HHSC holds a rate hearing, as required by Texas Administrative Code § 355.201.

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, and 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.

Next step for Providers: 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.