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Monoclonal Antibody Therapy Codes M0239 and Q0239 No Longer Benefits Effective April 30, 2021

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

On April 16th, 2021, the Food and Drug Administration (FDA) revoked the Emergency Use Authorization for bamlanivimab when administered alone. The FDA determined that the known and potential benefits of bamlanivimab, when administered alone, no longer outweigh the known and potential risks.

Effective April 30, 2021, antibody therapy procedure codes M0239 and Q0239 are no longer benefits of Texas Medicaid and the Children With Special Health Care Needs (CSHCN) Services Program.

Bamlanivimab used with etesevimab is still authorized and can be submitted with procedure codes M0245 and Q0245.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.