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 the article titled "First Quarter 2020 HCPCS Updates for Texas Medicaid," which was published on this website March 24, 2020. The article stated that procedure code C9058 will be added as a Medicaid benefit as of the Centers for Medicare & Medicaid Services effective date, April 1, 2020.
Procedure code C9058, which is the biosimilar to pegfilgrastim, will also be diagnosis restricted.
Providers may refer to the current Texas Medicaid Provider Procedures Manual, Clinician-Administered Drugs Handbook, subsection 22, “Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim,” for a list of payable diagnosis codes.
For more information, call the TMHP Contact Center at 800-925-9126.