Provider Alert! Clinical Criteria for Leqembi® (procedure code J0174) effective November 1, 2023
Date: September 26, 2023 Attention: Physicians Effective date for prior authorization criteria: November 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective November 1 2023, the Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Leqembi® (procedure code J0174) for fee-for-service Medicaid. Leqembi (Lecanemab-irmb) is an amyloid-beta directed antibody indicated for early stages of Alzheimer’s disease. Prior Authorization Requirements: Criteria for Initial Approval: Patient has Alzheimer’s disease (Diagnosis codes: G30.0, G30.1, G30.8 or...
