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 July 1, 2019, procedure codes Q5108 and Q5110 will be added to the colony stimulating factors policy.
Reimbursement is limited to the diagnosis codes listed in the Texas Medicaid Provider Procedures Manual, Clinician-Administered Drugs Handbook, Section 21 “Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim),” for filgrastim (procedure codes J1442, J1447, and Q5101), pegfilgrastim (procedure code J2505), sargramostim (procedure code J2820), and biosimilars (procedure codes Q5108 and Q5110)
For more information, call the TMHP Contact Center at 800-925-9126.