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Prior Authorization Criteria for Procedure Code J0490 Now Available In Lupus Treatment Agents Section of TMPPM Outpatient Drug Services Handbook

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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.

Providers can find information about procedure code J0490, including prior authorization criteria, in the current Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, section 6.72, “Lupus Treatment Agents.” 

On January 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) will remove procedure code J0490 from the TMPPM, Outpatient Drug Services Handbook, section 6.56, “Immunosuppressive Drugs.”

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