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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 : 9.2.51 Palivizumab Injections

RSV immune globulin, intramuscular palivizumab (Synagis) must be obtained through the Texas VDP. Providers must obtain prior authorization through the VDP.
Providers may not bill Texas Medicaid for RSV prophylaxis that was obtained through VDP; however providers may be reimbursed for administering the drug. Providers may refer to the HHSC Texas Medicaid/CHIP Vendor Drug Program website at for more information about obtaining palivizumab for Texas Medicaid clients.

Texas Medicaid & Healthcare Partnership
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