MedicaidPrior AuthMedium impact
June 2026 Updated Prior Authorization Criteria for Tezepelumab-Ekko (Tezspire) Procedure Code J2356
Texas Medicaid·TX · Allergy & Immunology, ENT (Ear, Nose & Throat)·Coding
Effective date
Jun 1, 2026
We identified it
May 2, 2026
Summary
Effective June 1, 2026, Texas Medicaid (TMHP) will require prior authorization for tezepelumab-ekko (Tezspire) injections using procedure code J2356 when used as maintenance treatment for chronic rhinosinusitis with nasal polyps in patients 12 years and older. This is a new prior authorization requirement that will affect billing for this specialty medication.
Action Required
Before June 1, 2026: Billing team must update system to require prior authorization for HCPCS code J2356 (tezepelumab-ekko/Tezspire) for Texas Medicaid patients with chronic rhinosinusitis with nasal polyps. Providers must obtain prior authorization from TMHP before administering treatment to patients 12+ years old. Contact TMHP at 800-925-9126 for authorization process details. For Medicaid MCO patients, contact the specific MCO as requirements may differ.