The TMHP fee schedule sets how much Texas Medicaid pays providers for medical services in 2026. It also sets a new $750 provider enrollment fee, up from $730 last year.
This guide breaks down the 2026 updates, key dates, and how patients and providers can find exact rates.
Quick Summary:
- Texas Medicaid providers pay a $750 enrollment fee in 2026 (institutional providers).
- Major rate updates hit on January 1, March 1, April 15, and May 21, 2026.
- Rates change by provider type, service code, and date of service.
- Use the free Online Fee Lookup (OFL) tool for exact numbers.
- This fee schedule affects providers, not what patients pay for care.
- Not sure if you qualify for coverage? Try our Medicaid Eligibility Calculator in 2026 to check in minutes.
What Is the TMHP Fee Schedule?
TMHP stands for Texas Medicaid & Healthcare Partnership. It manages Medicaid claims and payments for the state of Texas. The “fee schedule” is not one single document. It’s a live database that shows how much Medicaid pays for each service, based on the provider type and the date care was given.
Doctors, hospitals, and other providers use this schedule to bill Medicaid correctly. Patients don’t pay these rates directly, but the schedule affects which providers accept Medicaid and how much care costs the program overall.
Who Uses the TMHP Fee Schedule?
Providers across many specialties rely on this schedule to get paid correctly under Texas Medicaid’s fee-for-service and managed care systems.
Institutional Providers
Hospitals, nursing facilities, and similar large providers must enroll and pay the new $750 application fee starting January 1, 2026. This is up from $730 in the prior year.
Physicians and Specialists
Doctors, behavioral health providers, and radiation oncology specialists use the schedule to check reimbursement for specific procedure codes.
Ancillary Providers
Ambulatory surgical centers, diagnostic labs, dental providers, and durable medical equipment (DME) suppliers all follow HCPCS-based rate updates each year.
Good news for many providers: the $750 fee is waived if a provider already paid an enrollment fee to Medicare or another state’s Medicaid program.
2026 TMHP Fee Schedule Update Timeline
TMHP does not release one fixed schedule for the whole year. Instead, it publishes rate changes on a rolling basis as new data and policy decisions come in.
| Date | What Changed |
|---|---|
| January 1, 2026 | Annual HCPCS code update covering ambulatory surgical centers, labs, dental, DME, and radiology. Drug procedure code rates were also revised using Q4 2025 data. |
| March 1, 2026 | Rate hearing changes from November 2025 took effect. This updated fees for outpatient behavioral health, hearing aids, allergy testing, lab services, radiation oncology, and physician-administered oncology and vaccine drugs. |
| April 15, 2026 | TMHP published an off-cycle static fee schedule outside the normal quarterly update cycle. |
| May 21, 2026 | Additional reimbursement updates were made to specific HCPCS procedure codes. |
TMHP also automated several previously manual fee schedules — including Indian Health Services and hospital outpatient imaging — starting March 15, 2026, so these update faster going forward.
How to Find Your Exact Medicaid Rate
Because rates depend on provider type, specialty, and service date, there’s no single chart that covers every code. Texas Medicaid gives providers two official tools instead.
Online Fee Lookup (OFL): This is the most accurate, real-time tool. It shows an “Adjusted Fee” column with the final rate after any reductions are applied. You can search it directly at TMHP’s Fee Schedules page.
Static Fee Schedules: These are downloadable PDF and Excel files organized by category, like ambulance, physician, or vision services. They’re useful for reviewing broad rate categories rather than a single code.
If you’re a provider checking a specific code, like an office visit or a dental procedure, the OFL tool will give you the most current, accurate number for that service date.
What the Fee Schedule Means for Patients
The TMHP fee schedule sets what Texas Medicaid pays your provider. It does not set what you personally owe for care, and it doesn’t change your Medicaid eligibility.
Your eligibility depends on separate rules, like your household’s Modified Adjusted Gross Income (MAGI) and how it compares to the Federal Poverty Level (FPL). For example, the 2026 institutional Medicaid income limit in Texas is $2,982 per month for one person, with a $2,000 asset limit.
If you want to see how these numbers compare across the country, check our guide to Medicaid Income Limits by State in 2026. For a full breakdown of who qualifies and how, visit our page on Medicaid Eligibility in 2026.
Provider fee changes can also affect coverage indirectly. When reimbursement rates go up, more providers may choose to accept Medicaid patients, including for CHIP-enrolled children and managed care plans.
Frequently Asked Questions
Q: What is the TMHP fee schedule?
A: The TMHP fee schedule is the set of rates Texas Medicaid pays providers for medical services. It changes based on provider type, service code, and date of care. TMHP updates it through the Online Fee Lookup tool and downloadable static fee schedules rather than one single yearly document.
Q: How much is the Texas Medicaid provider enrollment fee in 2026?
A: Starting January 1, 2026, institutional providers like hospitals and nursing facilities pay a $750 enrollment fee, up from $730. The fee is waived if the provider already paid it to Medicare or another state’s Medicaid program that year.
Q: When do 2026 TMHP rate updates take effect?
A: Key 2026 updates took effect January 1 (annual HCPCS codes), March 1 (rate hearing changes), April 15 (off-cycle static schedule), and May 21 (additional HCPCS updates). More updates may be added as the year continues.
Q: How can I look up a specific Medicaid rate in Texas?
A: Use TMHP’s Online Fee Lookup (OFL) tool for the most current, accurate rate for a specific procedure code. It shows an “Adjusted Fee” after all reductions. Static fee schedule downloads are also available for broader service categories.
Q: Does the TMHP fee schedule affect my Medicaid eligibility as a patient?
A: No. The fee schedule sets provider payments, not patient eligibility. Your eligibility depends on your household income, size, and the Federal Poverty Level guidelines set separately by Texas Medicaid.
Q: How do I apply for Medicaid in Texas in 2026?
A: You can apply online through the Texas Health and Human Services portal, by phone, or in person at a local office. You’ll need proof of income, household size, and residency. After you submit, the state reviews your application and mails an eligibility determination.
Sources & Disclaimer
Written & Reviewed by: Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official Medicaid.gov and TMHP guidelines | Last Updated: July 2026
Sources:
CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official eligibility or rate information, contact TMHP or visit Medicaid.gov.
