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Update to TMPPM Outpatient Drug Services Handbook Effective June 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 June 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, section 6.109, “Spesolimab-sbzo (Spevigo),” to change the age restriction for procedure code J1747 from 18 years of age or older to 12 years of age or older.

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