MedicaidPrior AuthMedium impact
Benefit and Prior Authorization Information for Omidubicel-onlv (Omisirge)
Texas Medicaid·TX · Hematology, Oncology, Transplant Surgery +1 more·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Aug 5, 2026
Summary
Texas Medicaid is adding omidubicel-onlv (Omisirge), a cord blood stem cell therapy, as a covered benefit effective July 1, 2026, with prior authorization required beginning September 1, 2026. Providers must submit prior authorization requests using the Special Medical Prior Authorization (SMPA) Request Form for eligible patients with hematologic malignancies or severe aplastic anemia scheduled for stem cell transplantation.
Action Required
By September 1, 2026: Billing team must implement prior authorization workflow for procedure code J3590 (omidubicel-onlv infusion). Update billing system to flag claims with J3590 as requiring prior authorization on the Special Medical Prior Authorization (SMPA) Request Form before claim submission. Providers must verify patient eligibility based on diagnosis codes (D701, D708, D709, Z9481 for hematologic malignancies; D611, D612, D6189, D619 for severe aplastic anemia), age requirements (12+ for malignancies, 6+ for SAA), transplant donor status, and prior HSCT history before requesting prior authorization. Configure system to enforce sensitivity screening for dimethyl sulfoxide, Dextran 40, gentamicin, human serum albumin, and bovine material contraindications. Claims submitted without approved prior authorization will be denied. Contact TMHP at 800-925-9126 for clarification or MCO-specific procedures if applicable.