Author: CSRA
Effective Jan. 4, 2018, the North Carolina Medicaid and NC Health Choice (NCHC) programs will cover aprepitant injectable emulsion (Cinvanti), for intravenous use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.
Cinvanti is available as 130 mg in a single-dose vial. It is approved by the Food and Drug Administration (FDA) for adults, in combination with other antiemetic agents, for the prevention of:
- Acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy (HEC) including high-dose cisplatin
- Nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy (MEC)
Cinvanti has not been studied for treatment of established nausea and vomiting.
The recommended dose of Cinvanti is:
- HEC (Single Dose Regimen): 130 mg on Day 1 as an intravenous infusion over 30 minutes approximately 30 minutes prior to chemotherapy.
- MEC (3-Day Regimen): 100 mg administered on Day 1 as an intravenous infusion over 30 minutes approximately 30 minutes prior to chemotherapy. Aprepitant capsules (80 mg) are given orally on Days 2 and 3.
See full prescribing information for further detail.
For Medicaid and NCHC Billing
- The ICD-10-CM diagnosis code required for billing is Z51.11 - Encounter for antineoplastic chemotherapy.
- Providers must bill with HCPCS code J3490 - Unclassified drugs
- One Medicaid unit of coverage is 1 mg. NCHC bills according to Medicaid units.
- The maximum reimbursement rate per unit is $2.45.
- Providers must bill 11-digit National Drug Codes (NDCs) and appropriate NDC units. The NDC is 47426-0201-01.
- The NDC units should be reported as “UN1.”
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update.
- For additional information regarding NDC claim requirements related to the PDP, refer to the PDP Clinical Coverage Policy No. 1B, Attachment A, H.7 on Medicaid’s website.
- Providers shall bill their usual and customary charge for non-340-B drugs.
- PDP reimburses for drugs billed for Medicaid and NCHC beneficiaries by 340-B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340-B drugs shall bill the cost that is reflective of their acquisition cost. Providers shall indicate that a drug was purchased under a 340-B purchasing agreement by appending the UD modifier on the drug detail.
- The fee schedule for the PDP is available on Medicaid’s PDP web page.
CSRA 1-800-688-6696