MedicaidBilling CodesMedium impact
February 2026 TMPPM Update for Colony Stimulating Factors
Texas Medicaid·TX · Oncology, Hematology·General
Effective date
Feb 1, 2026
We identified it
Jan 17, 2026
Summary
Effective February 1, 2026, Texas Medicaid will cover efbemalenograstim alfa-vuxw, a new colony stimulating factor drug, using procedure code J9361. This drug is restricted to patients 18 years of age or older and requires age verification for proper billing.
Action Required
By February 1, 2026: Update billing system to include new HCPCS code J9361 for efbemalenograstim alfa-vuxw. Ensure age verification process is in place - this drug is restricted to patients 18 years and older. Contact patient's specific MCO for prior authorization requirements as these may vary by plan. Update drug administration encounter forms to include J9361.