MedicaidCoverageMedium impact
Vestronidase Alfa-Vjbk (Mepsevii) a Benefit in the Home Setting Effective July 1, 2026
Texas Medicaid·TX · Endocrinology, Pediatrics, Oncology·Policy
Effective date
Jul 1, 2026
We identified it
May 30, 2026
Summary
Starting July 1, 2026, Texas Medicaid will cover vestronidase alfa-vjbk (Mepsevii) when administered in the home setting using procedure code J3397. The drug's information is also being moved to a different section in the provider manual.
Action Required
By July 1, 2026: Billing team must update systems to recognize J3397 (vestronidase alfa-vjbk/Mepsevii) as covered by Texas Medicaid when provided in home setting. Update place of service codes to include home administration. Contact specific MCOs for prior authorization requirements as procedures may vary between traditional Medicaid and managed care organizations.