Age Restriction Update for Procedure Code J2781

Date: December 4, 2025

Attention: All Providers

Effective date: December 1, 2025

Call to action: Texas Children’s Health Plan (TCHP) informs providers that effective for dates of service on or after December 1, 2025, the age restriction for pegcetacoplan (Syfovre) (procedure code J2781) will be updated from 12 years of age or older to 18 years of age or older.

The Texas Medicaid & Healthcare Partnership (TMHP) will include this update in the December release of the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, section 6.98, “Pegcetacoplan (Empaveli).” In addition, the section title will be changed to “Pegcetacoplan (Syfovre).”

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: www.texaschildrenshealthplan.org/provideralerts.