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HCPCS Annual Update Coming January 2026

Date: 12/29/25

Superior HealthPlan would like to inform providers of important updates related to the Texas Medicaid & Healthcare Partnership (TMHP) Follow – Up to Healthcare Common Procedure Coding System (HCPCS) Annual Update Coming January 2026.

The TMHP will implement the 2026 HCPCS annual updates, including 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 adhere to the standard 95-day initial claims filing deadline. HCPCS procedure codes that are discontinued 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 rate hearing for the 2026 HCPCS updates is scheduled for March 2026.
  • A separate rate hearing will be held in February 2026 to propose reimbursement for long-acting reversible contraceptives (LARCs) and other services.
  • Hearing dates will be posted on the Health and Human Services Commission (HHSC) 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

Providers should note the following:

  • Claims billed to Superior HealthPlan for services rendered before expenditure approval will be denied with EOB 02008 (“DENY: NEW CODE. DO NOT RESUBMIT – WILL BE AUTOMATICALLY PROCESSED”). 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, Superior will identify and reprocess affected claims automatically within 60 Business Days of the date rates posted by TMHP.
  • Providers do not need to appeal unless denied for other reasons. Any reimbursement adjustments will appear on future Remittance and Status (R&S) reports.
  • If the effective date for a new procedure code is updated, TMHP will publish updates on its website. Clients 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. Superior will continue to communicate this requirement to providers.
  • Superior 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.

Please contact your Provider Representative if you have any questions. To access their contact information, visit Find My Provider Representative.