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Procedure Code J1303 Age and Diagnosis Update for Ultomiris

Last updated on 3/1/2021

Effective September 1, 2020, the age limitation for procedure code J1303 was removed for Medicaid and Children with Special Health Care Needs (CSHCN) Services Program clients.

Claims submitted for Medicaid clients with procedure code J1303 are restricted to diagnosis codes D588, D593, D594, and D598 for Medicaid clients of all ages. However, diagnosis code D595 will be limited to Medicaid clients 18 years of age and older when submitted with procedure code J1303. Claims submitted for CSHCN Services Program clients with procedure code J1303 are restricted to diagnosis code D593 only.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.