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Pegfilgrastim-pbbk (Fylnetra), Procedure Code Q5130, a Benefit of Texas Medicaid Effective November 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 November 1, 2023, colony stimulating factors pegfilgrastim-pbbk (Fylnetra), procedure code Q5130, will be a benefit of Texas Medicaid.

For a list of payable diagnosis codes, providers may refer to the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, subsection 6.28, “Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim).”

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