Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
Effective for dates of service on or after February 1, 2019, diagnosis code G7000 may be reimbursed when submitted with Eculizumab procedure code J1300.
For a list of payable diagnosis codes and restrictions, providers can refer to the Texas Medicaid Provider Procedures Manual, Clinician-Administered Drugs Handbook, subsection 6.1.4, “Nonspecific, Unlisted or Miscellaneous Procedure Codes.”
For more information, call the TMHP Contact Center at 800-925-9126.