Author: CSRA
Effective with date of service April 1, 2018, the North Carolina Medicaid and N.C. Health Choice (NCHC) programs cover fibrinogen concentrate (human) lyophilized powder for reconstitution (Fibryga) for use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3590 - Unclassified biologics. Fibryga is available as a lyophilized powder in single-use bottles containing approximately 1 g fibrinogen concentrate per bottle.
Fibryga is indicated for the treatment of acute bleeding episodes in adults and adolescents with congenital fibrinogen deficiency, including afibrinogenemia and hypofibrinogenemia. Fibryga is not indicated for dysfibrinogenemia. See full prescribing information for dosing information and further detail.
For Medicaid and NCHC Billing
- The ICD-10-CM diagnosis code required for billing is D68.2 - Hereditary deficiency of other clotting factors.
- Providers must bill with HCPCS code J3590 - Unclassified biologics.
- One Medicaid unit of coverage is 1 mg.
- The maximum reimbursement rate per unit is $1.19.
- Providers must bill 11-digit National Drug Codes (NDCs) and appropriate NDC units. The NDCs are 68982-0347-01 and 68982-0348-01.
- 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