Additional Place of Service and Provider Type Added for Procedure Code J7171

Date: December 26, 2025 

Attention: Providers 

Effective for dates of service on or after January 1, 2026

Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after January 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) may reimburse claims for the administration of Adzynma (procedure code J7171). These claims will be reimbursed when they are submitted through a specialty pharmacy and Adzynma is administered in the home setting.

Texas Medicaid managed care organizations (MCOs) like Texas Children’s Health Plan (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 at 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.