Pegfilgrastim-cbqv (Udenyca) to be Diagnosis Restricted Effective May 1, 2022

Date: July 1, 2022 Attention: All Providers Effective Date: May 1, 2022Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after May 1, 2022, pegfilgrastim-cbqv (Udenyca; procedure code Q5111), a granulocyte colony stimulating factor, will be restricted by diagnosis. How this impacts providers: Providers should refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 7.19, “Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim),” for a list of payable diagnosis codes for colony stimulating factors. Next steps for providers: Prescribers should adjust their prescribing patterns accordingly and share this update with their staff. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.