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Reimbursement Rate Updates for Drug Procedure Code J1455 Effective July 1, 2023

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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.

Effective for dates of service on or after July 1, 2023, reimbursement rate updates for injection procedure code J1455 (Foscavir) that were presented at a public rate hearing on May 19, 2023, will be implemented for Texas Medicaid.

Updates are available at Injection Foscavir.

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