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Added Payable Diagnosis Code and Age Restriction Change for Panhematin Procedure Code J1640

Last updated on 8/2/2019

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 August 1, 2019, procedure code J1640 is payable only when submitted with diagnosis code E80.21 (acute intermittent hepatic porphyria).

Additionally, effective August 1, 2019, there will no longer be an age restriction for procedure code J1640.

For more information, call the TMHP Contact Center at 800-925-9126.