Provider Alert! TMPPM Update for Monoclonal Antibodies Benralizumab, Mepolizumab, and Reslizumab
Date: May 24, 2022
Attention: All Providers
Effective Date: April 1, 2022
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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: Beginning April 1, 2022, Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook section 7.57.5, “Prior Authorization for Omalizumab, Benralizumab, Mepolizumab, and Reslizumab.”
How this impacts providers: Beginning April 1, 2022, Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook section 7.57.5, “Prior Authorization for Omalizumab, Benralizumab, Mepolizumab, and Reslizumab.” As follows:
The diagnosis codes J4450, J4451, and J4452, listed for benralizumab, mepolizumab, and reslizumab, respectively, are not valid.
The diagnosis codes will be updated as J4550, J4551, and J4552.
For more information, call the TMHP Contact Center at 800-925-9126.
Next steps for providers: Prescribers should share this communication with their staff
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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