Skip to main content

Reprocessing of Some Claims With Procedure Codes J0882 and Q4081

Last updated on

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.

The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue that affects some claims submitted with drug procedure codes J0882 and Q4081 for dates of service from July 1, 2023, through December 5, 2023, for the treatment of end-stage renal disease.

These claims may have been denied in error. Affected claims that were submitted with dates of service from July 1, 2023, through December 5, 2023, will be reprocessed. Reprocessing may result in an additional payment that will be reflected on future Remittance and Status (R&S) Reports.

Note: Procedure codes J0882 and Q4081 are excluded from the composite rate payment and are paid separately.

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