Hydroxyprogesterone Caproate (Makena) J1726 No Longer a Benefit Effective June 1, 2023


What is new

Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid was notified, that effective June 1, 2023, procedure code J1726, hydroxprogesterone caproate (Makena) will no longer be a benefit of Texas Medicaid.


Claims with procedure code J1726 with dates of service from April 6, 2023, through June 1, 2023, may be reprocessed. Affected claims may result in recoupment, which will be reflected on future Remittance and Status (R&S) Reports. No action required by the provider.


Providers, for questions or additional information, please:


The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.