Tag - allergen immunotherapy

Provider Alert!
22Aug

Provider Alert! Credentialing reminder for PCPs Administering Allergen Immunotherapy Services

Date: August 22, 2023 Attention: Primary Care Providers (PCPs) Call to action: Texas Children’s Health Plan (TCHP) would like to remind Primary Care Providers (PCPs) of the credentialing requirement when administering allergen immunotherapy services. How this impacts providers: Allergy testing and injections will be reimbursed only for PCPs who are credentialed as allergy specialists. An allergist / immunologist (commonly referred to as an allergist) is a physician specially trained to diagnose, treat and manage allergies, asthma and immunologic disorders including primary immunodeficiency disorders. TCHP...

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Provider Alert!
05Mar

Provider Alert! Prior Authorization Changes for Fasenra and Nucala

Date: February 19, 2021 Attention: Allergists & Immunologists, Pulmonologists Effective Date:  April 6, 2021 Call to action: Texas Children’s Health Plan (TCHP) is modifying prior authorization criteria for two monoclonal antibodies available through the pharmacy benefit: Fasenra (benralizumab) and Nucala (mepolizumab). Both are monoclonal antibodies approved for the treatment of severe asthma. The Texas Health and Human Services Commission (HHSC) revised the clinical prior authorization criteria for these agents to enhance appropriate utilization per the US Food and Drug Administration’s (FDA) approved indications and...

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07Sep

Clarification In Limitations of Allergen Immunotherapy

Based on recommendations of network providers, the immunotherapy preparation (CPT 95165) benefit has been modified to allow 80 units in 6 months. This will facilitate ease of payment for initial preparation of antigen mixture for new patients and is consistent with national guidelines. Subsequent to the initial preparation claim, Texas Children’s Health Plan anticipates immunotherapy preparation (CPT 95165) maintenance claims consistent with national guidelines. Billing Use of CPT code 95165, professional services for the supervision and provision of antigens for allergen immunotherapy in...

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01Aug

Clarification in Limitations of Allergen Immunotherapy

Based on recommendations of network providers, the immunotherapy preparation (CPT 95165) benefit has been modified to allow 80 units in 6 months. This will facilitate ease of payment for initial preparation of antigen mixture for new patients and is consistent with national guidelines. Subsequent to the initial preparation claim, Texas Children’s Health Plan anticipates immunotherapy preparation (CPT 95165) maintenance claims consistent with national guidelines. Billing Use of CPT code 95165, professional services for the supervision and provision of antigens for allergen immunotherapy in...

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