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.
Claim Submission for HCCAD Skysona With U3 Modifier (Procedure Code J3590) in a Hospital Setting
Date: July 10, 2025
Attention: Hospital Providers
Effective date: June 1, 2025
Call to action: Skysona (procedure code J3590) is a high-cost clinician-administered drug (HCCAD) that is currently a benefit of Texas Medicaid. For dates of service on or after June 1, 2025, hospitals with prior authorization can submit a separate outpatient claim for Skysona when the drug is provided in an inpatient setting. Providers should not submit a claim for Skysona on the related inpatient services claim.
How this impacts providers: Providers must submit the following elements on a fee-for-service (FFS) outpatient claim so that the Texas Medicaid & Healthcare Partnership (TMHP) can easily identify Skysona claims and reimburse them separately from the inpatient claims:
Procedure code J3590
Modifier U3
The appropriate national drug code (NDC)
The modification to the TMHP FFS claims processing system to reimburse Skysona at the fee schedule rate will not be complete until December 19, 2025. TMHP will initially process the outpatient claims for Skysona that are submitted by hospital providers at the current hospital outpatient reimbursement rate. TMHP will reprocess claims that are submitted before December 19, 2025, after the claims processing system modifications are complete.
Next step for Providers: Providers should share this communication with their billing staff.
