Author: CSRA
Effective with date of service Jan. 4, 2018, the North Carolina Medicaid and NC Health Choice (NCHC) programs cover etelcalcetide injection, for intravenous use (Parsabiv) for use in the Physician’s Drug Program (PDP) when billed with HCPCS code J0606 - Injection, etelcalcetide, 0.1 mg.
Parsabiv is available as a 2.5 mg/0.5 mL, 5 mg/mL or 10 mg/2 mL solution in a single-dose vial and indicated for secondary hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on hemodialysis. Parsabiv has not been studied in adult patients with parathyroid carcinoma, primary hyperparathyroidism or with CKD who are not on hemodialysis and is not recommended for use in these populations.
Recommended Dose:
- The recommended starting dose is 5 mg administered by intravenous bolus injection three times per week at the end of hemodialysis treatment.
- The maintenance dose range is 2.5 to 15 mg three times per week.
- The dose may be increased in 2.5 mg or 5 mg increments no more frequently than every four weeks.
See full prescribing information for further detail.
For Medicaid and NCHC Billing
- The ICD-10-CM diagnosis code required for billing is N25.81 - Secondary hyperparathyroidism of renal origin (must be billed with Z99.2 - Dependence on renal dialysis).
- Providers must bill with HCPCS code J0606 - Injection, etelcalcetide, 0.1 mg.
- One Medicaid and NCHC unit of coverage is 0.1 mg.
- The maximum reimbursement rate per unit is $3.53.
- Providers must bill 11-digit National Drug Codes (NDCs) and appropriate NDC units. The NDCs are 55513-0740-01, 55513-0740-10, 55513-0741-01, 55513-0741-10, 55513-0742-01 and 55513-0742-10.
- 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 North Carolina 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