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Abatacept (Orencia) Information Updated in TMPPM Outpatient Drug Services Handbook

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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.

On July 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, section 6.1, “Abatacept (Orencia).” TMHP will add the following information about the drug and its age requirements:

  • Abatacept (Orencia) (procedure code J0129) is a selective T-cell costimulation modulator.
  • The age limitation for psoriatic arthritis is 2 years of age or older.

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