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Updated Prior Authorization Criteria for Burosumab-Twza (Crysvita) Effective October 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.

Effective for dates of service on or after October 1, 2025, Texas Medicaid will update initial prior authorization criteria for burosumab-twza (Crysvita) (procedure code J0584). The Texas Medicaid & Healthcare Partnership (TMHP) may consider prior authorization for clients with a diagnosis of:

  • X-linked hypophosphatemia (XLH) (diagnosis code E8331 or E8339).
  • FGF23-related hypophosphatemia caused by an underlying tumor that cannot be located or removed with surgery (diagnosis code M838).

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