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Some Ustekinumab Drugs Will Be a Benefit of the CSHCN Services Program Effective July 1, 2025

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Effective for dates of service on or after July 1, 2025, the following procedure codes will be a benefit of the Children with Special Health Care Needs (CSHCN) Services Program:

  • Ustekinumab-ttwe (Pyzchiva), subcutaneous, procedure code Q9996
  • Ustekinumab-ttwe (Pyzchiva), intravenous, procedure code Q9997
  • Ustekinumab-aekn (Selarsdi), procedure code Q9998
  • Ustekinumab-aauz (Otulfi), procedure code Q9999

Procedure codes Q9996, Q9997, Q9998, and Q9999 will be limited to clients who are 6 years of age or older and restricted to the following diagnosis codes:

Diagnosis Codes
K5000K50011K50012K50013K50014K50018K50019K5010
K50111K50112K50113K50114K50118K50119K5080K50811
K50812K50813K50814K50818K50819K5090K50911K50912
K50913K50914K50918K50919K5100K51011K51012K51013
K51014K51018K51019K5120K51211K51212K51213K51214
K51218K51219K5130K51311K51312K51313K51314K51318
K51319K5180K51811K51812K51813K51814K51818K51819
K5190K51911K51912K51913K51914K51918K51919L400
L401L402L403L404L4050L4051L4052L4053
L4054L4059L408L409    

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.