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 December 1, 2019, physicians may be reimbursed for eteplirsen, procedure code J1428, rendered in the home setting.
For more information, call the TMHP Contact Center at 800-925-9126.