The Texas Medicaid Fee Schedule 2026 shows how much doctors get paid for Medicaid services. It lists exact payment rates for every medical procedure.
Texas Medicaid uses this fee schedule to pay healthcare providers. The rates apply to all doctors and hospitals in Texas.
Quick Facts:
- Texas Medicaid pays doctors using the fee-for-service system
- TMHP updates rates four times per year (quarterly)
- Children get higher rates than adults (age 0-20 vs 21+)
- Provider enrollment costs $750 for 2026
- Rates are uniform across all Texas counties
Page Contents
- 1 What Is the Texas Medicaid Fee Schedule?
- 2 How to Find the Fee Schedule
- 3 2026 Payment Rates
- 4 Key Changes for 2026
- 5 How Doctors Get Paid
- 6 Important Rules to Know
- 7 Frequently Asked Questions
- 7.1 What is the Texas Medicaid Fee Schedule 2026?
- 7.2 How often do Texas Medicaid rates change?
- 7.3 What is the 2026 conversion factor for children?
- 7.4 How much is the Texas Medicaid provider enrollment fee?
- 7.5 Do Texas Medicaid rates vary by city?
- 7.6 Where can I download the Texas Medicaid Fee Schedule?
What Is the Texas Medicaid Fee Schedule?
The Texas Medicaid Fee Schedule is a price list. It shows what Texas pays doctors for medical care.
Doctors cannot charge more than these rates. Texas pays the lower of the billed amount or the fee schedule rate.
The Texas Health and Human Services Commission (HHSC) sets these rates. The Texas Medicaid & Healthcare Partnership (TMHP) manages the daily work.
How to Find the Fee Schedule
You can view Texas Medicaid rates online. TMHP offers two ways to check prices.
Download Static Fee Schedules:
Visit public.tmhp.com/FeeSchedules. Download Excel or PDF files by doctor type.
Use the Online Fee Lookup:
Search current rates instantly. Look up procedure codes one at a time. View up to 24 months of past rates.
| Fee Schedule File | Provider Type |
|---|---|
| PRCR402C | Physician (General) |
| PRCR609C | Nurse Practitioner |
| PRCR496C | Dental Services |
| PRCR416C | Ambulance Services |
| PRCR415C | Texas Health Steps (Kids) |
| PRCR704C | Medical Equipment (DME) |
2026 Payment Rates
Texas Medicaid pays most doctors using the Resource-Based Fee method. This uses Medicare RVUs multiplied by Texas conversion factors.
2026 Conversion Factors:
| Patient Age | Payment Rate |
|---|---|
| Children (0-20) | $28.0672 |
| Adults (21+) | $26.7305 |
| Access-to-Care (Kids) | $30.00 |
Example: A procedure with 2.5 RVUs pays $70.17 for a child ($28.0672 × 2.5).
Key Changes for 2026
Provider Enrollment Fee Increased
Institutional providers now pay $750 to enroll. This fee is new for 2026.
Fee Schedule Automation
TMHP is moving manual fee schedules to automated formats. This helps rates update faster.
Removed Fee Schedules
PRCR419C and PRCR700C are gone. These services moved to other schedules.
How Doctors Get Paid
Texas Medicaid uses different payment rules for different services.
Hospital Services:
Inpatient hospitals use a prospective payment system. Outpatient hospitals use cost-based rates.
Drugs and Medicine:
Drug prices update every three months. They use Average Sales Price (ASP) data.
Mental Health:
Licensed Clinical Social Workers get 70% of psychologist rates. Certified Nurse Midwives get 70% of physician rates.
Important Rules to Know
Non-Emergency ER Visits:
Texas pays less for non-urgent ER care. Rural hospitals get 55% of standard rates. Non-rural hospitals get a flat rate.
Medicare Crossover:
If Medicare pays more than Texas Medicaid, you get no extra money. If Medicare pays less, Texas pays the difference.
Frequently Asked Questions
What is the Texas Medicaid Fee Schedule 2026?
It is a list of prices Texas pays doctors for Medicaid care. It shows exact dollar amounts for each medical service.
How often do Texas Medicaid rates change?
Rates update every three months (quarterly). Drug prices change quarterly too.
What is the 2026 conversion factor for children?
The rate is $28.0672 per RVU for kids under 21. Adults get $26.7305 per RVU.
How much is the Texas Medicaid provider enrollment fee?
It costs $750 for institutional providers in 2026. Individual doctors may have different fees.
Do Texas Medicaid rates vary by city?
No. Rates are uniform across all Texas counties. Rural and urban doctors get the same rates.
Where can I download the Texas Medicaid Fee Schedule?
Visit public.tmhp.com/FeeSchedules or pfd.hhs.texas.gov. Both sites offer free downloads.
Last Updated: January 30, 2026
Sources:
- Texas Medicaid & Healthcare Partnership (TMHP) – www.tmhp.com
- Texas Health and Human Services Commission – hhs.texas.gov
Ready to check your rates? Visit the TMHP Online Fee Lookup today to search current Texas Medicaid Fee Schedule 2026 rates by procedure code.
