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Texas MedicaidMedicaid · Billing Codes · General · TX · Allergy & Immunology, Pediatrics, Hematology +2 moreMedium impact

Limitation Update to the CSHCN Services Program Provider Manual for Immune Globulins

Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
Jan 31, 2026

Summary

Starting April 1, 2026, Texas Medicaid's CSHCN Services Program will only reimburse one of the three immune globulin procedure codes (J1571, J1573, or 90371) when billed on the same date of service by any provider. This prevents duplicate billing for immune globulin treatments.

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What to do

by Apr 1, 2026 · 3 steps
01Billing team must update system to flag and prevent billing multiple immune globulin codes (J1571, J1573, 90371) on the same date of service for CSHCN patients.
02Update billing edits to allow only one code per date.
03Train staff that only one immune globulin code will be reimbursed per day regardless of provider.

Codes mentioned

J1571J157390371

Original notice

Limitation Update to the CSHCN Services Program Provider Manual for Immune Globulins
tmhp.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Texas Medicaid policiesTX policy changesAllergy & ImmunologyPediatricsHematologyNeurologyInfectious DiseaseCode J1571Code J1573Code 90371

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