If you want to know about the Texas Medicaid fee schedule for 2026, start with the Texas Medicaid & Healthcare Partnership. TMHP manage the Online Fee Lookup, where current fee details, procedure-code searches, historical data, and — for logged-in providers — contracted rates actually live.
Quick answer: the fee schedule lists reimbursement information for services under applicable fee-schedule methodologies. To find a real number, use TMHP’s Online Fee Lookup or the correct static schedule, then check the procedure code, date of service, provider type, TOS, modifiers, and whether it’s fee-for-service or managed care. Skip any of those and you’ll likely land on the wrong figure.
What Is the Texas Medicaid Fee Schedule?
The Texas Medicaid Fee Schedule is a collection of published reimbursement information for certain services. It’s not one master price list covering every claim in the system.
Texas Medicaid runs on several reimbursement methodologies — fee schedules, reasonable-cost methodologies, hospital reimbursement methods, provider-specific encounter rates, reasonable-charge methodologies, and manual pricing. Finding a number next to a CPT or HCPCS code doesn’t automatically mean that’s what gets paid.
For services reimbursed through applicable fee schedules, TMHP explains payment can be the lower of the provider’s billed charge or the published Medicaid rate. Lower of the two. Not whichever looks better on paper.
Who Uses the Texas Medicaid Fee Schedule?
This information gets used constantly by:
- Physicians and other practitioners
- Medical billing companies
- Hospitals and facilities
- DME suppliers
- Dentists
- Laboratories
- Radiology providers
- Ambulance providers
- Healthcare administrators
- Revenue-cycle and compliance teams
- Researchers checking historical reimbursement
Patients can use fee-schedule information too, mostly to understand how reimbursement works. Just know that a provider’s acceptance of Texas Medicaid and a patient’s own coverage are separate questions.
Where to Find the Official Texas Medicaid Fee Schedule
TMHP administers the state’s provider resources and is the primary source. The current Provider Procedures Manual was updated August 31, 2026, with policy changes through September 1, 2026.
Here’s what’s available:
- Online Fee Lookup (OFL) for electronic searches
- Static Fee Schedules for downloadable files
- Texas Medicaid Provider Procedures Manual for reimbursement policy and instructions
- TMHP rate-change notices for current and historical updates
- Texas Administrative Code, Chapter 355, for the regulatory framework behind reimbursement rates
Static schedules come as Excel spreadsheets or PDFs. OFL, on the other hand, is a searchable tool — no download required.
How to Check a Texas Medicaid Reimbursement Rate
Looking for a CPT rate, HCPCS rate, or procedure-code reimbursement amount? Work through this in order.
Step 1: Identify the procedure code. Start with the actual CPT or HCPCS code. Don’t rely on a description like “office visit” or “lab test” — the exact code changes the result.
Step 2: Confirm the date of service. This one’s critical. TMHP’s OFL supports historical procedure-code searches for dates within the previous 24 months.
Step 3: Open TMHP’s Online Fee Lookup. Search the procedure directly. OFL handles individual codes as well as lists and ranges.
Step 4: Check TOS and modifiers. Type of Service identifies the category tied to a procedure. Texas HHS lists examples including medical services, surgery, radiology, laboratory, anesthesia, DME, home health, and Texas Health Steps.
Step 5: Review the fee information. Look at the applicable fee, the adjusted fee, and any other fields. Don’t assume the first number you see is the final payment.
Step 6: Verify the reimbursement methodology. Is this actually paid through a fee schedule, or through something else entirely?
Step 7: Confirm FFS versus managed care. If the member is enrolled in a Medicaid managed-care organization, the published fee-for-service rate might not even apply. If you’re unsure how MCO enrollment shifts the math, this breakdown of Medicaid work requirements by state touches on how eligibility categories interact with coverage type.
Online Fee Lookup vs. Static Fee Schedule
| Feature | Online Fee Lookup | Static Fee Schedule |
|---|---|---|
| Current fee research | Excellent | Useful |
| Individual code search | Yes | Yes |
| Multiple-code search | Yes | Useful for bulk review |
| Historical lookup | Yes, within supported period | Depends on file |
| Provider-specific contracted rates | Available to logged-in providers | Not the primary purpose |
| Downloadable file | No, primarily a lookup tool | Excel/PDF formats |
| Best use | Fast rate verification | Bulk analysis and documentation |
| TMHP describes OFL as providing real-time fee information and historical searches. Static schedules exist as downloadable files instead — better for bulk work, worse for quick checks. |
How to Read a Texas Medicaid Fee Schedule
A procedure code by itself rarely tells you enough. Pay attention to:
- Procedure code: CPT or HCPCS
- TOS: Type of Service
- Modifier: qualifies or changes how a service is reported
- Provider type: can shift which methodology applies
- Date of service: determines which rate period applies
- Facility/non-facility: matters for professional-service rates
- Fee: the published reimbursement amount
- Adjusted Fee: reflects the applicable adjusted amount
- Note codes: may carry additional payment information
- Benefit limitations: especially relevant for DME and dental services
Texas HHS guidance confirms TOS and procedure-code data are core parts of the fee-schedule structure.
What Does “Adjusted Fee” Mean?
An Adjusted Fee identifies the applicable adjusted payment amount under a given schedule and set of circumstances. Don’t interpret it in isolation — check the field definitions, date, and provider type first. Some Texas Medicaid payment guidance specifically uses the facility or non-facility adjusted fee when setting a payment standard.
CPT vs. HCPCS: What’s the Difference?
CPT codes describe medical, surgical, and professional services. HCPCS is broader, including Level II codes for supplies, equipment, and drugs. DME suppliers tend to live in HCPCS territory; physicians deal with CPT far more often.
Texas Medicaid Reimbursement Methodologies
The fee schedule is only one piece of the reimbursement system. Texas Medicaid documentation identifies several methodologies, including:
- Fee schedules
- Reasonable cost with interim rates
- Hospital reimbursement methodology
- Provider-specific encounter rates
- Reasonable-charge payment methodology
- Manual pricing
For physician and practitioner reimbursement, Texas rules also address resource-based and access-based fees, with certain resource-based methodologies relying on relative value units and a conversion factor. Assume every service runs through one statewide CPT table, and you’ll pick the wrong methodology — then land on the wrong conclusion.
Texas Medicaid Fee-for-Service vs. Managed Care
| Issue | Fee-for-Service Medicaid | Managed Care |
|---|---|---|
| Payment source | Texas Medicaid FFS methodology | Member’s MCO |
| Fee schedule relevance | Often central | May not be the contracted payment |
| Provider contract | Applicable Medicaid rules | MCO contract may apply |
| Prior authorization | Texas Medicaid rules | MCO-specific procedures may apply |
| Claims process | Traditional Medicaid process | Can vary by MCO |
| MCOs and dental plans aren’t required to follow Texas Medicaid fee schedules, so reimbursement can differ. TMHP’s 2026 notices tell providers to contact the member’s specific MCO directly, since authorization, referrals, and claims procedures vary by plan. | ||
| Bottom line: know whether the member is under fee-for-service Medicaid or a managed-care arrangement before comparing a claim payment against a published fee. |
Does the Date of Service Change the Texas Medicaid Rate?
Yes. A schedule published today isn’t necessarily the right one for a service performed months ago — and that matters a lot in 2026, since TMHP has issued multiple reimbursement updates throughout the year.
The TMHP rate-change listing includes September 2026 updates touching dental services, certain Medicaid procedure codes, DME, enteral supplies, and ambulance services.
September 2026 Texas Medicaid Rate Updates
For dates of service beginning September 1, 2026, TMHP implemented changes tied to its May 26, 2026 public rate hearing, covering surgery, hospital G codes, NEMT, physician-administered drugs, proton therapy, vision devices, DME, and dental services. A separate September 2026 DME and enteral-supplies update followed.
Downloading an old spreadsheet and calling it done? That’s how wrong answers happen.
Can You Check Historical Texas Medicaid Rates?
Yes — TMHP’s Online Fee Lookup supports historical procedure-code searches within its supported 24-month window. This matters when you’re:
- Auditing an old claim
- Investigating an underpayment
- Reviewing a denied claim
- Checking a previous contract period
- Reconstructing reimbursement
- Comparing a rate before and after an update
For anything older, you’ll need archived schedules and official TMHP documentation.
Provider-Specific and Contracted Rates
A common mistake: assuming every provider gets paid the exact same amount. Published rates can be uniform statewide by provider type, but TMHP also lets logged-in providers search their own contracted rates. This matters most once managed-care reimbursement enters the picture — and if you’re comparing this across state lines, the Medicaid fee schedule by state comparison is worth a look.
Texas Medicaid Fee Schedule by Service Category
Depending on the service, you’ll run into separate resources for physician and practitioner services, surgery, radiology, laboratory, dental, DME, drugs, ambulance, NEMT, home health, behavioral and therapy services, Texas Health Steps, hospital services, and vision-related services.
Don’t reach for a physician fee schedule when you’re dealing with DME, dental, hospital, or transportation claims — it won’t line up.
Common Texas Medicaid Billing Mistakes
Avoid these:
- Using the current rate for an old date of service
- Confusing FFS reimbursement with MCO reimbursement
- Ignoring TOS
- Overlooking modifiers
- Using the wrong provider type
- Assuming a listed fee guarantees payment
- Ignoring coverage requirements
- Failing to check prior authorization
- Using an outdated spreadsheet
- Treating a $0.00 entry as automatically meaning “payment is zero”
TMHP has published corrections before. February 2026 corrections addressed renal dialysis and nephrology rates off by one cent — TMHP stated no claims were affected.
How to Audit a Texas Medicaid Reimbursement Discrepancy
When your expected payment doesn’t match the remittance, work through this sequence: Code → Date → TOS → Modifier → Provider Type → Facility Status → Methodology → FFS/MCO → Coverage → Authorization → Claim/Remittance.
Confirm the code and date, then pull the official TMHP fee information. Review TOS and modifiers, determine FFS versus MCO, and check coverage and authorization. Compare the published fee against the billed charge and payment, check for any rate correction, and contact TMHP if you’re still stuck.
Does Texas Medicaid Have Different Rates in Houston, Dallas or Austin?
No — Texas Medicaid is statewide. Don’t assume Houston, Dallas, Austin, San Antonio, or El Paso runs its own physician fee schedule just because that’s where the provider sits. TMHP describes published fee-schedule rates as uniform statewide by provider type.
Searching “Texas Medicaid providers near me” is a different task entirely — finding providers, not determining reimbursement methodology. If eligibility is part of what you’re untangling, the Medicaid income limits guide covers how coverage thresholds are set at the state level.
FAQs
What is the Texas Medicaid fee schedule?
It’s a collection of Texas Medicaid reimbursement information for services paid under applicable fee-schedule methodologies. TMHP provides Online Fee Lookup and static schedules for eligible services.
Where can I find the Texas Medicaid Fee Schedule 2026?
Start with TMHP’s official fee-schedule and Online Fee Lookup resources. The current Provider Procedures Manual was updated August 31, 2026.
How do I check a Texas Medicaid CPT code rate?
Find the CPT code, confirm the date of service and provider type, then search it in TMHP’s Online Fee Lookup. Review TOS, modifiers, and applicable fee information before trusting the result.
Does Texas Medicaid have an HCPCS fee schedule?
Yes. HCPCS codes show up across Texas Medicaid reimbursement resources, including DME and drug-related schedules. The correct one depends on the service and methodology involved.
Can I check historical Texas Medicaid reimbursement rates?
Yes, within TMHP’s supported 24-month historical window.
Do Texas Medicaid MCOs use the same fee schedule?
Not necessarily. MCO reimbursement arrangements can differ from traditional fee-for-service Medicaid, so verify directly with the member’s specific MCO.
Does the date of service affect Texas Medicaid reimbursement?
Yes. Rate updates carry specific effective dates, so an older claim may use a different fee than what’s current now.
What does TOS mean on a Texas Medicaid fee schedule?
Type of Service. It identifies the service category tied to a procedure and often determines which reimbursement policies apply.
Does a Texas Medicaid fee guarantee payment?
No. Coverage, medical necessity, authorization, coding accuracy, billed charges, provider status, methodology, and managed-care arrangements can all affect the final payment.
Is there one Texas Medicaid reimbursement rate for every provider?
No. Payment based on the service, provider type, methodology, date, coding specifics, and whether the claim runs through fee-for-service or managed care.
Conclusion
Treat the Texas Medicaid Schedule as one piece of a larger system, not a price list you look up and walk away from. Start with TMHP, nail down the code and date of service, check TOS and modifiers, confirm the methodology, and know whether you’re in fee-for-service or managed care before trusting any number.
Rates shift throughout the year — the September 2026 updates prove that — so lean on current TMHP resources instead of an old spreadsheet.
Official Resources
- Check Texas Medicaid Rates — TMHP Online Fee Lookup
- Get Static Fee Schedules — TMHP
- Verify Reimbursement Rules — Texas Administrative Code, Chapter 355
- Find Program Policy Updates — Texas Health and Human Services Commission
This guide is for general informational purposes and is not billing, legal, medical, or reimbursement advice. Texas Medicaid rates, rules, and managed-care contracts can change. Always confirm the applicable rate and rules with latest official TMHP/HHSC resources before submitting or auditing a claim.