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 August 25, 2020, for dates of service on or after July 1, 2020, the reimbursement rate for procedure code J9177 (Enfortumab) has been updated.
The following link shows the updates: Procedure Code J9177 (Enfortumab)
Affected claims with dates of service from July 1, 2020, through August 25, 2020, if any are identified, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.
For more information, call the TMHP Contact Center at 800-925-9126.