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Age Limitation Update for Cerliponase Alfa (Brineura), Procedure Code J0567

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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. 

Effective for dates of service on or after March 1, 2025, the age limitation for cerliponase alfa (Brineura), procedure code J0567, will be updated to include pediatric clients of all ages. 

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