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April 2026 Updates in the TMPPM Outpatient Drug Services Handbook

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On April 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook as follows:

  • TMHP will add diagnosis codes M1909, M1919, and M1929 to section 6.133, “Triamcinolone Acetonide.” Providers must submit claims for procedure code J3304 with one of the diagnosis codes that are listed in this section of the TMPPM for the claims to be considered for reimbursement.
  • TMHP will add a new section, “Tocilizumab-bavi (Tofidence),” which lists procedure code Q5133 with the following diagnosis restrictions:
Diagnosis Codes
M0510M05111M05112M05119M05121M05122M05129M05131
M05132M05139M05141M05142M05149M05151M05152M05159
M05161M05162M05169M05171M05172M05179M0519M0520
M05211M05212M05219M05221M05222M05229M05231M05232
M05239M05241M05242M05249M05251M05252M05259M05261
M05262M05269M05271M05272M05279M0529M0530M05311
M05312M05319M05321M05322M05329M05331M05332M05339
M05341M05342M05349M05351M05352M05359M05361M05362
M05369M05371M05372M05379M0539M0540M05411M05412
M05419M05421M05422M05429M05431M05432M05439M05441
M05442M05449M05451M05452M05459M05461M05462M05469
M05471M05472M05479M0549M0550M05511M05512M05519
M05521M05522M05529M05531M05532M05539M05541M05542
M05549M05551M05552M05559M05561M05562M05569M05571
M05572M05579M0559M0560M05611M05612M05619M05621
M05622M05629M05631M05632M05639M05641M05642M05649
M05651M05652M05659M05661M05662M005669M05671M05672
M05679M0569M0570M05711M05712M05719M05721M05722
M05729M05731M05732M05739M05741M05742M05749M05751
M05752M05759M05761M05762M05769M05771M05772M05779
M0579M057AM0580M05811M05812M05819M05821M05822
M05829M05831M05832M05839M05841M05842M05849M05851
M05852M05859M05861M05862M05869M05871M05872M05879
M0589M058AM059M05AM0600M06011M06012M06019
M06021M06022M06029M06031M06032M06039M06041M06042
M06049M06051M06052M06059M06061M06062M06069M06071
M06072M06079M0609M060AM0680M06811M06812M06819
M06821M06822M06829M06831M06832M06839M06841M06842
M06849M06851M06852M06859M06861M06862M06869M06871
M06872M06879M0689M068AM069M0800M0820M08211
M08212M08219M08221M08222M08229M08231M08232M08239
M08241M08242M08249M08251M08252M08259M08261M08262
M08269M08271M08272M08279M0829M082AM083M0880
M0890R7681      

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.