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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 : Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim)
Colony stimulating factors (CSFs) are growth factors (glycoproteins) that support survival, clonal expansion and differentiation of blood forming cells and are a benefit of Texas Medicaid. CSFs reduce the likelihood of neutropenic complications due to chemotherapy and bone marrow transplant.
Filgrastim (procedure codes J1442 and Q5101) and pegfilgrastim (procedure code J2505) are granulocyte colony stimulating factors (G-CSFs). Sargramostim (procedure code J2820) is a granulocyte- macrophage colony stimulating factor (GM-CSF). GM-CSF and G-CSF stimulate neutrophil production after autologous bone marrow transplant and significantly reduce the duration and impact of neutropenia. To submit claims for reimbursement of colony stimulating factors, providers must submit the most appropriate procedure code with the number of units administered.
Procedure code J2505 is not reimbursed when submitted with the same date of service as procedure code J1442.
One of the following diagnosis codes must be billed with the appropriate procedure code:

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