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Procedure Code J3031 to Become a Payable Benefit Effective September 1, 2022

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Effective for dates of service on or after September 1, 2022, procedure code J3031 (Ajovy) will become a payable benefit of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for clients 18 years of age or older.

Procedure Code J3031

Procedure code J3031 will become payable to the following Medicaid providers and places of service:

Medicaid

Place of Service

Provider Type

Office

County Indigent Health Care Program, Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist

Outpatient Hospital

Hospital Providers

CSHCN Services Program

Procedure code J3031 will become payable to the following CSHCN Services Program providers and places of service:

Place of Service

Provider Type

Office

Physicians, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist

Outpatient Hospitals

Hospital Providers

Reimbursement

The following reimbursement rate changes and updates for procedure codes were presented at a public rate hearing on May 16, 2022:

Procedure Code J3031 Reimbursement Rate

For more information, refer to the Health and Human Services (HHS) Rate Packets web page at pfd.hhs.texas.gov/rate-packets, or call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.