Clinician Administered Drug Authorization Changes

Date: August 24, 2026

Attention: Providers

Effective Date: October 1, 2026

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective October 1, 2026, the following J-codes will require authorization. Authorization criteria can be found in the Texas Medicaid Provider Procedures Manual (TMPPM) Outpatient Drug Services Handbook.

Providers should review the following information and ensure prior authorization is obtained for the applicable J-codes for dates of service on or after October 1, 2026.

How this impacts providers: Starting on October 1, 2026, dates of services these J-codes require authorization.

Provider Next Steps: Review the list of affected J-codes and determine whether upcoming services will require prior authorization.

• Review the applicable authorization criteria in the TMPPM Outpatient Drug Services Handbook.
• Obtain prior authorization for applicable services with dates of service on or after October 1, 2026.
• Verify the appropriate Medicaid-payable HCPCS code and corresponding NDC using the Texas Medicaid NDC-to-HCPCS Crosswalk.

Notes for providers: For Anemia products, J1439 and J0138 will not require authorization; For Inflammatory Diseases, Q5103 and Q5121 for infliximab biosimilars will not require authorization; and for Neutropenia products, J1447, Q5101, and Q5110 for biosimilars for filgrastim and J2506 for the reference pegfilgrastim will not require authorization. Please check the Texas Medicaid NDC-to-HCPCS crosswalk to identify the correct NDC associated with the Medicaid-payable HCPCS code. 

If you have any questions, please contact the TCHP UM Department

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.