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Additional Place of Service and Provider Type Added for Procedure Code J7171

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Effective for dates of service on or after January 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) may reimburse claims for the administration of Adzynma (procedure code J7171). These claims will be reimbursed when they are submitted through a specialty pharmacy and Adzynma is administered in the home setting.

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.

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