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Update to TMPPM Outpatient Drug Services Handbook Effective January 1, 2025

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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 January 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, section 6.104, “Ravulizumab-cwvz (Ultomiris)” and section 6.14, “Azacitidine (Vidaza).”

The following updates will be made:

  • Diagnosis code G360 will be added as a payable diagnosis for ravulizumab-cwvz (Ultomiris) (procedure code J1303).
  • Diagnosis code C9200 will be added as a payable diagnosis for azacitidine (Vidaza) (procedure code J9025).

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