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Outpatient Drug Services Handbook Update for Hematopoietic Injections

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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 September 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, section 6.56, “Hematopoietic Injections.”

This update will add benefit information for procedure codes J0882 and Q4081 for clients with end-stage renal disease (ESRD). 

Refer to the current TMPPM, Clinics and Other Outpatient Facility Services Handbook, section 6.2.2, “Renal Dialysis Facilities-Consolidated Billing,” for information about procedure codes J0882 and Q4081.

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