Updated Prior Authorization Criteria for Burosumab-Twza (Crysvita)

Date: August 20, 2025

Attention: All Providers

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 initial prior authorization criteria for burosumab-twza (Crysvita) (procedure code J0584).

The Texas Medicaid & Healthcare Partnership (TMHP) may consider prior authorization for clients with a diagnosis of:

• X-linked hypophosphatemia (XLH) (diagnosis code E8331 or E8339).
• FGF23-related hypophosphatemia caused by an underlying tumor that cannot be located or removed with surgery (diagnosis code M838).

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.