Date: January 3, 2024
Attention: Providers
Effective date: November 1, 2023
Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after November 1, 2023, colony stimulating factors pegfilgrastim-pbbk (Fylnetra), procedure code Q5130, is a benefit of Texas Medicaid.
How this impacts providers: For a list of payable diagnosis codes, providers may refer to the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, subsection 6.28, “Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim).” https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2024/2024-01-january/2_15_Outpatient_Drug.pdf
There is not a prior authorization requirement for procedure code Q5130.
Next step for Providers: Providers should share this communication 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.