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Update to ‘Ado-trastuzumab emtansine (KADCYLA)
Procedure Code J9354 to Be a Benefit of Texas
Medicaid’
Information posted December 18, 2014
Note: This article applies to claims submitted to TMHP for processing. For claims
processed by a Medicaid managed care organization (MCO), providers must refer to the
MCO for information about benefits, limitations, prior authorization, and reimbursement.
This is the update to an article titled, “Ado-trastuzumab emtansine
(KADCYLAKADCYLA®) Procedure Code J9354 to Be a Benefit of Texas Medicaid,”
which was published on this website on July 15, 2014. The reimbursement rate has
been approved.
Effective for dates of service on or after July 1, 2014, the reimbursement rate of
procedure code J9354 is $29.14 for medical services rendered to Texas Medicaid clients
of all ages.
This reimbursement rate for procedure code J9354 is for services rendered by a
physician, nurse practitioner (NP), clinical nurse specialist (CNS), or physician assistant
(PA) in the office or outpatient hospital setting.
For more information, call the TMHP Contact Center at 1-800-925-9126.