Texas MedicaidMedium ImpactBilling Codes
February 2026 TMPPM Update for Colony Stimulating Factors
Published January 17, 2026Effective February 1, 2026
AI Summary
Effective February 1, 2026, Texas Medicaid will cover efbemalenograstim alfa-vuxw, a new colony stimulating factor drug, using procedure code J9361. This drug is restricted to patients 18 years of age or older and requires age verification for proper billing.
Action Required
By February 1, 2026: Update billing system to include new HCPCS code J9361 for efbemalenograstim alfa-vuxw. Ensure age verification process is in place - this drug is restricted to patients 18 years and older. Contact patient's specific MCO for prior authorization requirements as these may vary by plan. Update drug administration encounter forms to include J9361.
Affected Billing Codes
J9361
Plan Types
Medicaid
States
TX
Specialties
oncology, hematology