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 June 1, 2020, benralizumab, mepolizumab, and omalizumab may be provided in the home setting for Texas Medicaid. Procedure codes J0517, J2182, and J2357 will be a benefit in the home setting when services are provided by medical supplier (durable medical equipment) providers.
Providers may refer to the current Texas Medicaid Provider Procedures Manual, Clinician-Administered Drugs Handbook, subsection 41, “Monoclonal Antibodies Asthma and Chronic Idiopathic Urticaria,” for additional benefit information.
For more information, call the TMHP Contact Center at 800-925-9126