Author: CSRA
North Carolina Medicaid was recently made aware that several manufacturers of viscous hyaluronic acid products changed the status of their products from “drugs” to “devices” effective Oct. 24, 2017 and are therefore no longer offering rebate agreements with the Centers of Medicare & Medicaid Services (CMS). For this reason, North Carolina Medicaid will no longer cover the viscous hyaluronic acid products listed below:
- J7321 Hyaluronan or derivative, intra-articular injection (Hyalgan or Supartz)
- J7323 Hyaluronan or derivative, intra-articular injection (Euflexxa)
- J7324 Hyaluronan or derivative, for intra-articular injection (Orthovisc)
- J7325 Hyaluronan or derivative, intra-articular injection (Synvisc)
- J7326 Hyaluronan or derivative, for intra-articular injection (Gel-One)
- J7327 Hyaluronan or derivative, for intra-articular injection (Monovisc)
- J7328 Sodium hyaluronate injection, for intra-articular injection (Gelsyn-3)
Professional and outpatient pharmacy claims submitted for the above listed HCPCS codes/products with a date of service after Oct. 24, 2017 will be denied.
Per the information available from CMS, the following hyaluronic acid products continue to be listed as “drugs” and their manufacturer continues to have a CMS rebate agreement. Therefore, North Carolina Medicaid will continue to cover the following products:
- J3470 Hyaluronidase injection (Amphadase and Vitrase)
- J3473 Hyaluronidase, recombinant (Hylenex)
Providers will be notified of any change in coverage in a future bulletin should the status of the above products change.
Additional information can be found on the CMS Medicaid Drug Rebate Program web page and North Carolina Medicaid’s PDP Clinical Coverage Policy and PDP Fee schedule web page.
CSRA 1-800-688-6696