Jan. 15, 2026
What’s new: Blue Cross and Blue Shield of Texas Medicaid announced important updates related to the Texas Medicaid & Healthcare Partnership (TMHP) Follow – Up to Healthcare Common Procedure Coding System (HCPCS) Annual Update Coming January 2026.
Key Deadlines and Timelines: The Texas Medicaid and Healthcare Partnership implementation for 2026 HCPCS annual updates, include additions, revisions, and deletions, for dates of service on or after January 1, 2026. Providers must submit claims using the applicable 2026 HCPCS procedure codes beginning January 1, 2026, and submit claims prior to the standard 95-day initial claims filing deadline. Discontinued HCPCS procedure codes will no longer be Texas Medicaid benefits and will not be reimbursed for services provided after December 31, 2025.
- The 2026 HCPCS updates apply to dates of service on or after January 1, 2026.
- A separate rate hearing will be held in February 2026 to propose reimbursement for long-acting reversible contraceptives and other services.
- A rate hearing for the 2026 HCPCS updates is scheduled for March 2026.
- Hearing dates will be posted on the Health and Human Services Commission Meetings and Events website and published in the Texas Register.
Texas Medicaid must approve expenditures before reimbursement rates can be adopted. New benefits must undergo the rate hearing process to allow for public comment.
The TMHP will publish information related to the 2026 HCPCS updates on the TMHP website according to the following timeline:
- December 31, 2025: Website article identifying new and discontinued 2026 HCPCS procedure codes
- By February 1, 2026: Special bulletin containing benefit information related to the 2026 HCPCS updates
Claims Submission and Reimbursement:
Providers should note the following:
- Claims billed to BCBSTX for services rendered before expenditure approval will be denied with EOB 02008. If expenditures are approved, providers will receive a future notification with the applicable effective dates of service. If not approved, the procedure code will not be added as a covered benefit effective January 1, 2026.
- Once expenditures are approved, we will identify and reprocess affected claims automatically.
- Providers do not need to appeal unless denied for other reasons. Any reimbursement adjustments will appear on future Remittance and Status reports.
- If the effective date for a new procedure code is updated, TMHP will publish updates on its website. Members may not be billed for services provided outside of a procedure code’s effective date.
- To avoid submitting fraudulent claims, providers must always use the procedure codes that most accurately reflect the services provided. We will continue to communicate this requirement to providers.
- We will identify and reprocess any affected claims related to the HCPCS updates.
- Providers do not need to resubmit, or appeal claims unless the claims are denied for reasons unrelated to the HCPCS updates after reprocessing is complete.
If you have questions or require assistance, please reach out to your Medicaid Provider Network Team at 855-212-1615 or email.