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Reimbursement Rate Updates for Procedure Code J9144 Effective April 1, 2021

Last updated on 6/4/2021

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 June 8, 2021 for dates of service on or after April 1, 2021, the reimbursement rate for procedure code J9144 (Darzalex Faspro) will be implemented.

The following link shows the updates: Procedure Code J9144 (Darzalex Faspro)

Affected claims, if any are identified, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.

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