Provider Alert! Clinical Criteria Implementation for Enzyme Replacement Hormonal Therapy Agents effective May 1, 2024
Date: April 18, 2024 Attention: All Providers Effective Date: May 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective May 1, 2024, the Texas Health and Human Services (HHSC) will implement clinical prior authorizations to Adzynma (procedure code C9167) and Pombiliti (procedure code J1203) to the Enzyme Replacement Therapy (ERT) policy. Prior Authorization Requirements Apadamtase alfa (Adzynma), procedure code C9167 is indicated to treat the following: Pediatric and adult clients for prophylactic or on-demand ERT for congenital...
