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Implementation on hold for ‘Benefit Changes for Gene Expression Profiling Procedure Code 81519’

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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.

This is an update to an article titled “Benefit Changes for Gene Expression Profiling Procedure Code 81519 Effective March 1, 2020,” which was published on this website on January 10, 2020.

Changes to diagnosis and gender restrictions for procedure code 81519 previously scheduled for implementation March 1, 2020, are on hold pending further review. Additional information regarding these updates will be provided as it becomes available.

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