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Prior Authorization Criteria to Change for Omalizumab (Xolair) Effective March 1, 2022

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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, precertification, 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 March 1, 2022, prior authorization criteria will change for omalizumab (Xolair) procedure code J2357.

Prior authorization requests for clients with chronic idiopathic urticaria will no longer require documented failure of or contraindication to leukotriene inhibitor therapy.

For more information, call the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 800-925-9126.