Flu Season Alert!Alerta de temporada de influenza:
Don’t let germs win this season – protect yourself and your family!
The flu vaccine is your best defense against flu and related complications – PLUS, it is a covered benefit for Texas Children’s Health Plan members! Learn more!
¡No permitas que los gérmenes ganen esta temporada! ¡Protégete a ti y a tu familia!
La vacuna contra la influenza es tu mejor defensa contra la influenza y sus complicaciones. Además, ¡es un beneficio cubierto para los miembros de Texas Children's Health Plan! Aprende más
Claim Submission for HCCAD Skysona With U3 Modifier (Procedure Code J3590) in a Hospital Setting
Date: July 10, 2025
Attention: Hospital Providers
Effective date: June 1, 2025
Call to action: Skysona (procedure code J3590) is a high-cost clinician-administered drug (HCCAD) that is currently a benefit of Texas Medicaid. For dates of service on or after June 1, 2025, hospitals with prior authorization can submit a separate outpatient claim for Skysona when the drug is provided in an inpatient setting. Providers should not submit a claim for Skysona on the related inpatient services claim.
How this impacts providers: Providers must submit the following elements on a fee-for-service (FFS) outpatient claim so that the Texas Medicaid & Healthcare Partnership (TMHP) can easily identify Skysona claims and reimburse them separately from the inpatient claims:
Procedure code J3590
Modifier U3
The appropriate national drug code (NDC)
The modification to the TMHP FFS claims processing system to reimburse Skysona at the fee schedule rate will not be complete until December 19, 2025. TMHP will initially process the outpatient claims for Skysona that are submitted by hospital providers at the current hospital outpatient reimbursement rate. TMHP will reprocess claims that are submitted before December 19, 2025, after the claims processing system modifications are complete.
Next step for Providers: Providers should share this communication with their billing staff.
