Texas MedicaidMedium ImpactBilling Codes
Procedure Code Q5135 Updated to Include Valid Diagnosis Code M0529
Published May 30, 2026Effective October 1, 2024
AI Summary
Texas Medicaid corrected an invalid diagnosis code M0259 to valid code M0529 for tocilizumab-aazg (Tyenne) injection procedure code Q5135, effective for dates of service October 1, 2024 and later. TMHP will automatically reprocess affected claims and has waived the 120-day appeal deadline for this issue.
Action Required
Immediately: Billing team must update billing system to use diagnosis code M0529 (not M0259) when billing procedure code Q5135 for tocilizumab-aazg injections. Review any denied claims with dates of service on or after October 1, 2024, for this procedure as TMHP will automatically reprocess them. No appeals needed unless claims are denied for additional reasons after reprocessing.
Affected Billing Codes
Q5135M0259M0529
Plan Types
Medicaid
States
TX
Specialties
rheumatology, oncology