Benralizumab, Mepolizumab, and Omalizumab Benefits in the Home Setting

Attention: Pulmonologists, Allergists, and DME Providers Effective Date: For dates of service on or after June 1, 2020 Providers 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. Call to action: Texas Children’s Health Plan (TCHP) aligns with the new guidelines from the Health and Human Services Commission (HHSC) for dates of service on or after June 1, 2020, benralizumab, mepolizumab, and omalizumab may be provided in the home setting for Texas Medicaid. How this impacts providers: Procedure codes J0517, J2182, and J2357 will be a benefit in the home setting when medical supplier, Durable Medical Equipment (DME) provides the services. Next steps for providers: Providers may refer to the current Texas Medicaid Provider Procedures Manual, Clinician-Administered Drugs Handbook, subsection 41, “Monoclonal Antibodies Asthma and Chronic Idiopathic Urticaria,” for additional benefit information. 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.