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Update to TMPPM Outpatient Drug Services Handbook Effective February 1, 2024

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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.

On February 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook section 6.59, “Infliximab (Remicade), Inflectra, Renflexis,” to add Avsola (procedure code Q5121) and update the diagnosis code restrictions table.

Updates to Diagnosis Code Restrictions

In addition to the diagnosis codes that are currently listed in section 6.59, “Infliximab (Remicade), Inflectra, Renflexis,” the following codes will be added:

Diagnosis Codes
M057AM058AM060AM068AM45A0M45A1M45A2
M45A3M45A4M45A5M45A6M45A7M45A8M45AB

Procedure codes J1745, Q5103, Q5104, and Q5121 will have the same diagnosis restrictions.

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