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Age Restriction Update for Procedure Code J2781

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Effective for dates of service on or after December 1, 2025, the age restriction for pegcetacoplan (Syfovre) (procedure code J2781) will be updated from 12 years of age or older to 18 years of age or older.

The Texas Medicaid & Healthcare Partnership (TMHP) will include this update in the December release of the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, section 6.98, “Pegcetacoplan (Empaveli).” In addition, the section title will be changed to “Pegcetacoplan (Syfovre).”

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.