Skip to main content

Update to TMPPM Outpatient Drug Services Handbook for Ravulizumab-cwvz (Ultomiris)

Last updated on

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.

On July 1, 2022, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook section 6.72, “Ravulizumab-cwvz (Ultomiris).”

Diagnosis codes G7000 and G7001 will be added as payable diagnoses for ravulizumab-cwvz (procedure code J1303.)

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