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Additional Diagnosis Code Added for Procedure Code J0585

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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.

Effective for dates of service on or after July 1, 2021, diagnosis code N319 will be added as a payable diagnosis for Onabotulinum Toxin A (procedure code J0585).

For a list of additional payable diagnosis codes and restrictions, providers may refer to the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 7.10, “Botulinum Toxin Type A and Type B.”

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