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Update to Physician Chapter in CSHCN Services Program Provider Manual

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There will be a correction to the Physician chapter of the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, section 31.2.26.5, “Injection Procedure Codes,” and section 31.2.26.11, “Erythropoietin Alfa (EPO) and Darbepoetin.” The sections incorrectly list discontinued diagnosis code D593, and the code will be removed.

In addition, the diagnosis limitations for eculizumab (procedure code J1300) and ravulizumab-cwvz (Ultomiris) (procedure code J1303) will be updated in section 31.2.26.5 as follows:

  • Procedure code J1300: Diagnosis codes D5910, D5911, D5912, D5913, D5919, D5930, D5932, and D5939 will be added.
  • Procedure code J1303: Diagnosis codes D5930, D5931, D5932, and D5939 will be added.

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.