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Update to “Reimbursement Updates for Certain Renal Dialysis Drugs 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.

This is an update to the article titled “Reimbursement Updates for Certain Renal Dialysis Drugs Effective January 1, 2025,” which was published on this website on November 27, 2024.

Reimbursement for daprodustat (procedure code J0889) will not change on January 1, 2025.

Procedure code J0889 is not a benefit of Texas Medicaid and will not be reimbursed.

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