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Home Setting Allowed for Beremagene Geperpavec-svdt (Vyjuvek) Effective January 1, 2024

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after January 1, 2024, beremagene geperpavec-svdt (Vyjuvek) (procedure code J3401) administered in the home setting is a benefit of Texas Medicaid.

Affected claims that were submitted with dates of service on or after January 1, 2024, will be reprocessed. Providers may receive additional payment, which will be reflected on future Remittance and Status (R&S) Reports.

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