Texas Medicaid Fee Schedule 2026: Rates, Updates & Provider Guide

Last Updated: January 2026

The Texas Medicaid fee schedule 2026 sets the payment rates that providers receive for treating Medicaid patients in Texas.

Effective January 1, 2026, TMHP (Texas Medicaid & Healthcare Partnership) rolled out major coding and administrative updates that every provider must know.

Understanding these changes helps you bill correctly, get paid on time, and stay compliant.

Quick Summary:

• Provider enrollment application fee rose to $750 (up from $730)
• HCPCS annual code updates are active for all claims dated Jan 1, 2026+
• NCCI Q1 edits went live January 25, 2026, affecting bundled procedures
• The Dual Demo (MMP) program ended in Bexar and Dallas counties
• LTC income cap is $2,982/month for individuals in 2026
• Use the TMHP Online Fee Lookup (OFL) for real-time, accurate rates

What Changed in the Texas Medicaid Fee Schedule for 2026

Several important updates took effect at the start of 2026. These changes affect how providers enroll, how they bill, and which codes they use.

Staying on top of these updates helps you avoid claim denials and payment delays.

Provider Enrollment Fee Increase

Starting January 1, 2026, the institutional enrollment application fee increased to $750, up from $730. This applies to hospitals, nursing facilities, and other institutional providers enrolling or re-enrolling in Texas Medicaid.

Individual and group providers should verify their specific fee requirements at TMHP.com or through the Texas Health and Human Services Commission (HHSC).

Key Effective Dates at a Glance

HCPCS Annual Code Updates (Effective January 1, 2026)

TMHP implemented the 2026 Healthcare Common Procedure Coding System (HCPCS) updates. This means:

• New procedure codes were added
• Some codes were revised
• Outdated codes were discontinued

Any claim with a date of service on or after January 1, 2026 must use the new codes. Claims using discontinued codes will be denied. Always verify your codes before submitting.

NCCI Q1 2026 Edits (Effective January 25, 2026)

The National Correct Coding Initiative (NCCI) Q1 edits went into effect on January 25, 2026. These edits affect:

• Bundled procedures — some codes can no longer be billed together
• Mutually exclusive procedures — codes that cannot occur in the same patient visit
• Claims submitted on or after this date are subject to the new bundling rules

Providers who bill multiple services in one visit should review the NCCI edits carefully. Incorrect bundling leads to automatic claim rejections.

MMP Dual Demonstration Program Ended

The Medicare-Medicaid Plans (MMP) Dual Demonstration Program in Bexar County and Dallas County has officially ended as of January 2026.

Members previously enrolled in plans like Molina’s MMP have been transitioned to standard STAR+PLUS managed care.

If your patients were in the Dual Demo, verify their new plan before billing to avoid claim rejections.

EVV Policy Handbook Update (January 30, 2026)

A revised Electronic Visit Verification (EVV) Policy Handbook was released on January 30, 2026. This update sets new standards for:

• Program providers offering home and community-based services
• Financial Management Services Agencies (FMSAs)

EVV is required for personal care and home health services under Texas Medicaid. Non-compliance can result in payment holds.

How to Access the 2026 Texas Medicaid Fee Schedule

Providers have two main options to view reimbursement rates. TMHP strongly recommends the Online Fee Lookup (OFL) for accuracy.

Here is a quick comparison:

How to use the OFL:

1. Go to TMHP.com
2. Click Resources
3. Select Online Fee Lookup
4. Enter your procedure code and service date

Use the static fee schedules only when you need to download a full specialty list, such as for dental or ambulance services.

Fee-for-Service vs. Managed Care Rates

This is one of the most important distinctions for Texas Medicaid providers.

Fee-for-Service (FFS): The rates published by TMHP apply to Traditional Medicaid (Fee-for-Service). Very few Texas Medicaid patients are in FFS today.

Managed Care Organizations (MCOs): Most Texas Medicaid patients are enrolled in MCO programs like:

• STAR (for families and children)
• STAR+PLUS (for adults with disabilities and elderly)

⚠️ Important: MCOs negotiate their own rates. The state fee schedule often serves as a floor or benchmark, not the final rate. Always check your specific MCO contract for what you will actually be paid.

2026 Texas Medicaid Income Limits for Patients

While the fee schedule governs what providers are paid, income limits determine who qualifies for Texas Medicaid. If your patient’s income exceeds these limits, they may not be eligible for standard Medicaid coverage.

For a full breakdown of eligibility rules by household size, see our guide on Texas Medicaid eligibility 2026 and Texas Medicaid income limits in 2026.

These limits are set by the federal government and Texas HHSC. For comparisons across states, see our full guide on Medicaid income limits by state 2026.

Quick Stats: Texas Medicaid Fee Schedule 2026

Who Uses This Fee Schedule?

The Texas Medicaid fee schedule is used by:

• Physicians and specialists billing under Traditional Medicaid
• Home health agencies subject to EVV requirements
• Nursing facilities and hospitals with the new $750 enrollment fee
• Billing departments verifying code validity before claim submission
• Compliance officers reviewing NCCI bundling edits

For managed care providers, your MCO contract is the primary rate source. The state fee schedule is a reference point, not your final payment rate.

Medicaid Fee Schedule 2026: National Context

Texas is not the only state updating its Medicaid reimbursement rates. The federal Centers for Medicare & Medicaid Services (CMS) issues annual HCPCS updates that all states must implement.

For a broader comparison, visit our article on the Medicaid fee schedule 2026 at the national level to see how Texas compares to other states.

You can also find official national guidance at the CMS Medicaid website.

Frequently Asked Questions (FAQ)

Sources: Texas Medicaid & Healthcare Partnership (TMHP) | Texas Health and Human Services Commission (HHSC) | Centers for Medicare & Medicaid Services (CMS)

Last Updated: January 2026