Labor Day Holiday Día del Trabajo

Texas Children's Health Plan will be closed on Monday, September 1st, in observance of Labor Day. In our absence, you can reach our after-hours nurse help line at 1-800-686-3831. We will resume normal business hours on Tuesday, September 2nd. Wishing you a safe and happy Labor Day!

Texas Children's Health Plan estará cerrado el lunes 1 de septiembre por el Día del Trabajo. Durante nuestra ausencia, puedes comunicarse con nuestra línea telefónica de ayuda fuera del horario habitual al 1-800-686-3831. Reanudaremos nuestro horario regular el martes 2 de septiembre. ¡Te deseamos un feliz y seguro Día del Trabajo!

New Rewards Coming Soon! ¡Se vienen nuevas recompensas!

Our Healthy Rewards Program is getting an update in September! For a sneak peek of all the changes - including new rewards and ways to redeem them - please click here.

¡Nuestro Programa Healthy Rewards tendrá su actualización en septiembre! Para ver un adelanto de todos los cambios, incluyendo nuevas recompensas y formas de canjearlas, haz clic aquí.

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Pegfilgrastim-pbbk (Fylnetra), Procedure Code Q5130, a Benefit of Texas Medicaid

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.