MedicaidPrior AuthMedium impact
Physician Administered Drug Coverage and PA Requirement
Mississippi Medicaid (DOM)·MS·Prior Authorization
Effective date
Oct 15, 2026
We identified it
Sep 29, 2026
Summary
Effective October 15, 2026, Medicaid will cover Nexviazyme (J0219) as a physician-administered drug when given during office visits, but prior authorization from Telligen is now required before administering or billing this code. Claims submitted without prior authorization will be denied.
Action Required
By October 15, 2026: Billing team must implement prior authorization requirement for HCPCS code J0219 (Nexviazyme/avalglucosidase alfa-ngpt) in the billing system. Update all encounter forms and provider workflows to require PA documentation before administering or billing J0219. Designate staff to submit authorization requests to Telligen via their website (https://msmedicaid.telligen.com/) or phone (1-855-625-7709). Register for access to Telligen's Qualitrac provider portal to streamline PA submissions. Train providers and billing staff that claims for J0219 submitted without prior authorization will be denied.