The Texas Health and Human Services Commission (HHSC) conducted a public hearing to receive public comments on proposed rates for the Medicaid Biennial Calendar Fee Review, Healthcare Common Procedural Coding System Updates (HCPCS), and Medical Policy Reviews.
The effective date of the proposed payment rates for the topics presented during the rate hearing will be as follows:
Proposed to be effective January 01, 2026:
HCPCS Updates
Non-Quarterly HCPCS Drugs – Skysona – J3387
Non-Quarterly HCPCS Drugs – Ohtuvayre – J7601
Proposed to be effective March 01, 2026:
Calendar Fee Review
Ambulance Services
Proposed to be effective April 01, 2026:
Calendar Fee Review
Long-Acting Reversible Contraceptives (LARCs)
Proposed to be effective May 01, 2026:
Medical Policy Review
Senate Bill 989: Biomarker Testing
Proposed to be effective June 01, 2026:
Medical Policy Review
Office Setting Skin Substitute Codes
HCPCS Updates The rate packet states the effective date to be January 1, 2025 but the notice says January 1, 2026.
Click HERE to download the full report.