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Texas Medicaid Prior Authorization for Onasemnogene Abeparvovec-Xioi (Zolgensma) Will Change on October 1, 2025

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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 October 1, 2025, prior authorization criteria for onasemnogene abeparvovec-xioi (Zolgensma) will be updated.

In addition to diagnosis code G120, the following spinal muscular atrophy diagnosis codes will also be considered for prior authorization: G121, G128, and G129.

Refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.96.2, “Documentation Requirements,” for more information about prior authorization criteria.

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