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Diagnosis and Age Restrictions to Change for Hydroxyprogesterone Caproate Procedure Code J1729

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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 August 1, 2023, diagnosis codes O09211, O09212, O09213, and O09219 will be removed as payable diagnoses for hydroxyprogesterone caproate (procedure code J1729).

Procedure code J1729 will be restricted to clients who are nonpregnant women when billed with the following diagnosis codes:

Diagnosis Codes

C541

N897

N910

N911

N912

N925

N938

Procedure code J1729 will no longer be age restricted.

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