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.
Beginning April 1, 2022, Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook section 7.57.5, “Prior Authorization for Omalizumab, Benralizumab, Mepolizumab, and Reslizumab.”
The diagnosis codes J4450, J4451, and J4452, listed for benralizumab, mepolizumab, and reslizumab, respectively, are not valid.
The diagnosis codes will be updated as J4550, J4551, and J4552.
For more information, call the TMHP Contact Center at 800-925-9126.