Relenza may be billed using procedure code G9018 for each 10 mg of powder. Tamiflu may be billed using procedure code G9019 for each 75 mg tablet. TMHP will process claims for physician-administered Relenza and Tamiflu only for the duration of the pandemic.
Relenza is reimbursed at a fee of $5.48, and Tamilfu is reimbursed at a fee of $8.30. Administration procedure codes are not payable for procedure codes G9018 or G9019.
These antiviral medications are currently available by prescription through the Texas Vendor Drug Program (VDP) for clients enrolled in Texas Medicaid, the Children’s Health Insurance Program (CHIP), or the CSHCN Services Program. No prior authorization is required, and the drugs do not count against adult Medicaid clients with a three-prescription limit. Pharmacists may compound the Tamiflu capsule into a suspension.
For additional information about seasonal influenza, providers can refer to articles on the influenza web page of this website or to the state of Texas influenza website at www.texasflu.org.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.