Provider Alert! Additional Diagnosis Codes and Place of Service Added for Ravulizumab-cwvz (Ultomiris)
Attention: Hematologists, Gastroenterologists, Rheumatologists
Effective Date: June, 1 2020
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: Texas Children’s Health Plan (TCHP) would like to inform you that we align with Texas Medicaid Provider Procedure Manual (TMPPM) regarding the guidelines for ravulizumab-cwvz, (Ultomiris), procedure code J1303. The following diagnosis codes have been added as a payable diagnosis for J1303: D588, D593, D594, D595 and D598. A prior authorization is not required for this procedure code.
How this impacts providers: Additional TMPPM guidelines state the following:
- Place of service- office or outpatient hospital
- Members 18 years of age and older
Next steps for providers: Providers should communicate these guideline changes to their staff.
References:
Additional Diagnosis Codes and Place of Service Added for Ravulizumab-cwvz (Ultomiris)
TMPPM Clinician-Administered Drugs Handbook
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
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