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Update to Age Requirement for Prior Authorization of Inotuzumab Ozogamicin (Besponsa) for the CSHCN Services Program

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Effective for dates of service on or after July 1, 2024, the age requirement for prior authorization of inotuzumab ozogamicin (Besponsa) (procedure code J9229) will be expanded to include pediatric and adult clients who are one year of age or older.

Refer to the current Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, subsection, “Inotuzumab ozogamicin (Besponsa),” for additional prior authorization criteria.

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.