MedicaidBilling CodesMedium impact
November 2026 TMPPM Update for Colony Stimulating Factors
Texas Medicaid·TX · Oncology, Hematology, Internal Medicine·General
Effective date
Nov 1, 2026
We identified it
Oct 8, 2026
Summary
Effective November 1, 2026, Texas Medicaid will add two new biosimilar procedure codes to the Colony Stimulating Factors section of the TMPPM Outpatient Drug Services Handbook: Q5169 (Pegfilgrastim-unne/Armlupeg) and Q5172 (Filgrastim-laha/Filkri). Billing teams must update their systems to recognize and properly bill these codes for Texas Medicaid members.
Action Required
By November 1, 2026: Billing team must update the practice's billing system and fee schedules to recognize procedure codes Q5169 (Pegfilgrastim-unne/Armlupeg biosimilar) and Q5172 (Filgrastim-laha/Filgrastim biosimilar) for Texas Medicaid claims. Verify that claims processing software correctly maps these codes to the Colony Stimulating Factors drug category. Contact the member's specific Texas Medicaid MCO to confirm any prior authorization, precertification, or referral requirements that may differ from traditional Medicaid, as administrative procedures vary by MCO. Retain this policy update in the TMPPM Outpatient Drug Services Handbook reference materials for staff training and claims auditing.