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Cold and flu season Temporada de influenza y resfriados

ALERT: Stay healthy this cold and flu season! Learn more

ALERTA: ¡Mantente sano durante esta temporada de influenza y resfriados! Más información

New Website! ¡Nuevo sitio web!

ALERT: We have made the Texas Children’s Health Plan website even easier to use! Click here to learn more.

ALERTA: ¡Ahora el sitio web de Texas Children’s Health Plan es aún más sencillo de usar! Haz clic aquí para más información.

Enfamil shortage updates Escasez de Enfamil Reguline

ALERT: Shortage of Enfamil products until October 31, 2024. Learn more.

ALERTA: Escasez de productos de Enfamil hasta el 31 de octubre de 2024. Más información.

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Second Quarter 2022 HCPCS Updates for Texas Medicaid

Date: July 27, 2022Attention: All ProvidersEffective Date: July 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 Texas Medicaid & Healthcare Partnership (TMHP) implemented the second quarter 2022 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2022. How this impacts providers: The following drug procedure codes will be added as Medicaid benefits effective July 1 2022:
HCPCSDrug Name
C9094Sutimlimab-jome
C9095Tebentafusp-tebn
C9096Filgrastim-ayow (Releuko)
C9097Faricimab-svoa
J0739Cabotegravir
J1306Inclisiran
J1551Immune globulin (cutaquig)
J2779Ranibizumab, via intravitreal implant (susvimo)
J2998Plasminogen tvmh 1mg
J3299Triamcinolone acetonide (xipere)
J9331Injection, sirolimus protein-bound particles
J9332Injection, efgartigimod alfa-fcab
C9098Ciltacabtagene autoleucel
  Age limitations will apply for the following procedure codes:
Procedure CodesClient Age Limitation
C9094, C9095, J1306, J933118 years of age or older
J073910 years of age or older
J15512 years of age or older
J235612 years of age or older
 
  • Procedure code C9096, which is a granulocyte colony stimulating factor, will be restricted by diagnosis.
  • Refer to subsection 6.23, “Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim),” in the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook for a list of payable diagnosis codes for colony stimulating factors.
  • Procedure code J2356 will be restricted to diagnosis codes J4550 and J4551 for dates of service from July 1, 2022, through July 31, 2022.
  • Procedure code J2998 will be restricted to diagnosis code E8802.
  • Procedure code J9332 will be limited to clients who are 18 years of age or older and restricted to diagnosis codes G700 and G7001.
Next steps for providers: Providers are encouraged to share this communication 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