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Tildrakizumab (Ilumya) a Benefit of Texas Medicaid Effective May 1, 2019

Last updated on 8/6/2019

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 May 1, 2019, procedure code J3245 is a benefit of Texas Medicaid for clients who are 18 years of age and older as follows:

Place of Service

When Services are Provided by

Office

Nurse practitioner, clinical nurse specialist, physician assistant, and physician providers

Outpatient hospital

Hospital providers

Procedure code J3245 is restricted to diagnosis code L400.

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