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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.

Some Ustekinumab Drugs Will Be a Benefit of Texas Medicaid

Date: July 10, 2025

Attention: Providers

Effective date: July 1, 2025

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after July 1, 2025, the following procedure codes will be a benefit of Texas Medicaid:

  • Ustekinumab-ttwe (Pyzchiva), subcutaneous, procedure code Q9996
  • Ustekinumab-ttwe (Pyzchiva), intravenous, procedure code Q9997
  • Ustekinumab-aekn (Selarsdi), procedure code Q9998
  • Ustekinumab-aauz (Otulfi), procedure code Q9999

How this impacts providers: Procedure codes Q9996, Q9997, Q9998, and Q9999 will be limited to clients who are 6 years of age or older and restricted to the following diagnosis codes:

Diagnosis Codes
K5000K50011K50012K50013K50014K50018K50019K5010 
K50111K50112K50113K50114K50118K50119K5080K50811 
K50812K50813K50814K50818K50819K5090K50911K50912 
K50913K50914K50918K50919K5100K51011K51012K51013 
K51014K51018K51019K5120K51211K51212K51213K51214 
K51218K51219K5130K51311K51312K51313K51314K51318 
K51319K5180K51811K51812K51813K51814K51818K51819 
K5190K51911K51912K51913K51914K51918K51919L400 
L401L402L403L404L4050L4051L4052L4053 
L4054L4059L408L409     

Texas Medicaid managed care organizations (MCOs) like TCHP must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO/TCHP. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should reference a member’s specific MCO/TCHP for information on these items. For TCHP, this information can be found on the provider page available here https://www.texaschildrenshealthplan.org/providers.

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: www.texaschildrenshealthplan.org/provideralerts.