Provider Alert! Age and diagnosis restrictions for Code J0180tcph
Effective Date: July 28, 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) aligns with the Texas Medicaid Provider Procedures Manual (TMPPM) and there is no authorization requirement for Fabrazyme Injection, agalsidase beta Code J0180. TCHP does apply age and diagnosis restrictions; members must be eight years of age and older with a diagnosis of Fabry disease.
How this impacts providers:. Providers should follow the restrictions described above.
Next steps for providers: Providers should inform their staff of the restrictions.
If you have any questions, please email Provider Network Management at: firstname.lastname@example.org.