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Pegcetacoplan (Empaveli) Age Restriction Update Effective October 1, 2025

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Effective for dates of service on or after October 1, 2025, pegcetacoplan (Empaveli) (procedure code J2781) will be a benefit of Texas Medicaid for clients who are 12 years of age or older and have C3 glomerulopathy or primary immune-complexmembranoproliferative glomerulonephritis.

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

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.