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Brexanolone (Zulresso) Age Limitation Expanded Effective September 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 September 1, 2022, the age limitation will change for Brexanolone (Zulresso) procedure code J1632.

The Food and Drug Administration has expanded the age limitation for Brexanolone (Zulresso) procedure code J1632 to be used in clients who are 15 years of age or older with prior authorization.

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