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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 4 Outpatient Hospital (Medical and Surgical Acute Care Outpatient Facility) : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.20 Respiratory Services : * Pentamidine Aerosol
Aerosol pentamidine treatments are reimbursed using procedure code 94642. Providers may also be reimbursed for pentamidine medication using procedure code J2545.
Reimbursement for aerosol pentamidine treatment is limited to the following diagnosis codes:
Aerosol pentamidine treatments are limited to one treatment every 28 days.
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 Texas Medicaid.

Texas Medicaid & Healthcare Partnership
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