Treatment Indications to Change for Ferric Carboxymaltose

Date: June 17, 2022Attention: All ProvidersEffective Date: July 1, 2022Providers 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.TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal claims unless denied for other reasons.Providers should direct questions to their Provider Relations Liaison or send an email inquiry to the Provider Relations Department at providerrelations@texaschildrens.org. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective July 1, 2022, ferric carboxymaltose (procedure code J1439) will be restricted to patients who are one year and older and treatment indications will be updated. How this impacts providers: Beginning July 1, 2022, ferric carboxymaltose (procedure code J1439) may be indicated for but not limited to treatment of iron deficiency anemia for the following:

• Adult and pediatric clients who are one year of age or older with intolerance or unsatisfactory response to oral iron
• Adult clients with non-dialysis-dependent chronic kidney disease

Next steps for providers: Providers should share this update 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.