Diagnosis and Age Restrictions to Change for Hydroxyprogesterone Caproate Procedure Code J1729

Date: August 9, 2023

Attention: OB Providers

Effective date: August 1, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware of changes made to Hydroxyprogesterone Caproate, Procedure Code J1729.

How this impacts providers: Changes are as follows:

• Effective August 1, 2023, diagnosis codes O09211, O09212, O09213, and O09219 will be removed as payable diagnoses for hydroxyprogesterone caproate (procedure code J1729).
• Procedure code J1729 will no longer be age restricted.
• Procedure code J1729 will be restricted to clients who are non- pregnant women when billed with the following diagnosis codes:
  • C541
  • N897
  • N910
  • N911
  • N912
  • N925
  • N938

Next step for Providers: Providers should communicate this information with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers