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, diagnosis codes D588, D593, D594, D595 and D598 will be added as payable diagnoses for Ravulizumab-cwvz (Ultomiris) (procedure code J1303). Additionally, procedure code J1303 may be reimbursed in the office setting.
For more information, call the TMHP Contact Center at 800-925-9126.