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

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

This is a correction to the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, section 6.74, “Ravulizumab-cwvz (Ultomiris).” This section incorrectly lists discontinued diagnosis code D593, and it will be removed. Diagnosis codes D5930, D5932, and D5939 will be added to section 6.74.

The diagnosis restrictions for procedure code J1303 will be updated in this section. The following diagnosis codes are restricted to procedure code J1303:

Diagnosis Codes

D588

D5930

D5932

D5939

D594

D595

D598

G7000

G7001