Date: September 3, 2025
Attention: All Providers
Subject: Updated Prior Authorization Criteria for Onasemnogene Abeparvovec-Xioi (Zolgensma)
Effective dates: October 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 October 1, 2025, Texas Medicaid will update prior authorization criteria for Onasemnogene Abeparvovec-Xioi (Zolgensma).
In addition to diagnosis code G120, the following spinal muscular atrophy diagnosis codes will also be considered for prior authorization: G121, G128, and G129.
Refer to the current Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, subsection 6.96.2, “Documentation Requirements,” for more information about prior authorization criteria.
Next steps: 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.texaschildrenshealthplan.org/provideralerts.