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36.4.5.3 Bacillus Calmette-Guérin (BCG) Intravesical for Treatment of Bladder Cancer
BCG intravesical, instillation (procedure code 1-J9031) and for bladder cancer for intravesical use (procedure code 1-90586) are benefits of the Texas Medicaid Program for the following diagnosis codes:
BCG vaccine (procedure code 1-90585) is considered for reimbursement when submitted with diagnosis code V032.
BCG intravesical vaccines will autodeny for all other diagnosis codes. Bladder instillation of anticarcinogenic agent (procedure code 2-51720) may be reimbursed separately when billed separately.
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