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Benefit Changes for Gene Expression Profiling Procedure Code 81519 Effective March 1, 2020

Last updated on 1/10/2020

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 March 1, 2020, diagnosis and gender restrictions for procedure code 81519 will change for Texas Medicaid.

Procedure code 81519 will no longer be restricted to females only, and may be reimbursed when billed with the following additional diagnosis codes:

Diagnosis Codes

C50021

C50022

C50121

C50122

C50221

C50222

C50321

C50322

C50421

C50422

C50521

C50522

C50621

C50622

C50821

C50822

C50911

C50912

C50921

C50922

Z170

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