TMPPM Update for Healthy Texas Women and Microbiology Procedure Code G0433

Date: February 3, 2026

Attention: Providers

Effective date: April 1, 2026

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective April 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will implement updates to the Texas Medicaid Provider Procedures Manual (TMPPM) to update the limitation for procedure code G0433. Changes will appear in:

• Healthy Texas Women Program Handbook, Section 2.3: Services, Benefits, Limitations, and Prior Authorization
• Radiology and Laboratory Services Handbook, Section 2.11: Microbiology

How this impacts providers: For Procedure Code G0433, the following billing limitation begins on April 1, 2026:
Claims for procedure code G0433 will be denied if they are billed on the same date of service, by any provider, as procedure code 86703.

Next step for Providers: Providers should review their staff’s billing practices to ensure compliance with this update and prevent claim denials.

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

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