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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.39 Clinician-Administered Drugs : Vitamin B12 (Cyanocobalamin) Injections
Vitamin B12 injections are a benefit of Texas Medicaid. Vitamin B12 injections should only be considered for clients with conditions that are refractory to, or have a contraindication to, oral therapy.
Vitamin B12 injections may be considered for the following indications:
Procedure code J3420 must be used when billing for Vitamin B12 (cyanocobalamin) injections. Vitamin B12 (cyanocobalamin) injections are limited to the following diagnosis codes:
Claims that are denied for indications or other diagnosis codes may be considered on appeal with documentation of medical necessity. For the list of diagnosis codes above, documentation in the medical record must include rationale as to why the client was unable to be treated with oral therapy.

Texas Medicaid & Healthcare Partnership
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