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First Quarter 2026 HCPCS Updates for Texas Medicaid

Texas Medicaid·TX · Orthopedics, Wound Care, Oncology·Coding
Effective date
Apr 1, 2026
We identified it
Apr 2, 2026
Days to comply

Summary

Texas Medicaid is implementing first quarter 2026 HCPCS updates effective April 1, 2026, adding new covered and non-covered procedure codes with specific age limitations and prior authorization requirements. Several existing codes are being discontinued with direct replacements required.

Action Required

Action needed
By April 1, 2026: Billing team must update system to add new covered and non-covered procedure codes, implement age restrictions for specific codes (18+ for C9818, J1164, J3404, J8502, J9183, J9278, J9601; 12+ for J9277; birth-20 for L2221), configure prior authorization requirements for C8007, C8011, J3404, and L2221, replace discontinued codes C9145 with J8502, C9307 with J9601, and C9308 with J9278, and restrict J9601 to diagnosis codes C9000 and C9002. Update encounter forms and train staff on new requirements. Claims will be denied for discontinued codes after March 31, 2026.

Affected Billing Codes

C9818
J0463
J1164
J3404
J8502
J9183
J9277
J9278
J9601
Q5162
C8007
C8008
C8009
C8010
C8011
C8012
C8013
G0681
G0682
G0683
G0684
L2221
C9309
J1098
J1553
J9003
Q0238
Q5161
A2040
A2041
A2042
A2043
A2044
A2045
A4318
A4479
A6548
A8005
A8006
A9294
C1743
G0680
L5992
M0233
M0234
Q4418
Q4419
Q4421
Q4422
Q4423
Q4424
Q4425
Q4426
Q4427
Q4428
Q4429
Q4435
Q4436
Q4437
Q4438
Q4439
Q4440
C9145
C9307
C9308
L6000
L6010
L6020
C9000
C9002
J0681
J3389
J7528
J9161
J9174
J9248
Q5134
Q5148
Q5160
J7299
C6930
C6931
C6932
C6940
C6941
C6942
K50111
K50114
K50118
K50918
K50914
K50919
K50011
K5080
K50013
K50811
K50018
K50812
K50112
K50913
K50813
K5000
K50814
K50014
K50818
K50113
K5090
K5010
K50911
K50012
K50912
G35A
G35C0
G35D
G35C1