Skip to main content

Hematopoietic Injection Updates for Texas Medicaid Effective October 1, 2025

Last updated on

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.

Diagnosis Code Changes to Procedure Codes J0881, J0885, and J0888

Effective for dates of service on or after October 1, 2025, Texas Medicaid will update the diagnosis code requirements for the following hematopoietic injection procedure codes:

Procedure CodeDiagnosis Code AddedDiagnosis Codes Removed
J0881D464N185, N186
J0885I120N185, N186
J0888n/aI120, I1311, I132, N185, N186

Providers can refer to the current Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, subsection 6.59, “Hematopoietic Injections,” for a list of additional allowed diagnosis codes. On October 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will update that subsection to reflect the diagnosis code changes listed in the table.

Procedure Codes J0882 and Q4081 to Be Removed From Outpatient Drug Services Handbook

On October 1, 2025, TMHP will also update the TMPPM to remove procedure codes J0882 and Q4081 from the Outpatient Drug Services Handbook.

Providers can refer to the current TMPPM, Clinics and Other Outpatient Facility Services Handbook, subsection 6.2.2, “Renal Dialysis Facilities—Consolidated Billing,” for benefit information about procedure codes J0882 and Q4081.

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