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36.4.32 Pentamadine, Aerosol
Aerosol pentamidine treatments will be reimbursed using procedure code 1-94642.
Additionally, the provider may also be reimbursed for the medication using procedure code 1-J2545.
Payment for aerosol pentamidine treatments is limited to the following diagnosis codes:
Oral trimethoprim-sulfamethoxazole is available from pharmacies for self administration at home. The use of oral trimethoprim-sulfamethoxazole is not a payable benefit of the insured portion of the Texas Medicaid Program.
Aerosol pentamidine treatments are limited to one treatment every 28 days.
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