Effective with date of service April 7, 2020, the Medicaid and NC Health Choice programs cover meloxicam injection, for intravenous use (Anjeso™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Strength/Package Size(s): Injection: 30 mg/mL single-dose vial
Indicated for use in adults for the management of moderate-to-severe pain, alone or in combination with non-NSAID analgesics.
Because of delayed onset of analgesia, Anjeso™ alone is not recommended for use when rapid onset of analgesia is required.
Recommended Dose: 30 mg once daily, administered by intravenous bolus injection over 15 seconds. See full prescribing information for further detail.
For Medicaid and NC Health Choice Billing
- The ICD-10-CM diagnosis code(s) required for billing is/are:
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G89.0 - Central pain syndrome |
G89.11 - Acute pain due to trauma |
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G89.12 - Acute post-thoracotomy pain |
G89.18 - Other acute postprocedural pain |
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G89.21 - Chronic pain due to trauma |
G89.22 - Chronic post-thoracotomy pain |
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G89.28 - Other chronic postprocedural pain |
G89.29 - Other chronic pain |
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G89.3 - Neoplasm related pain (acute) (chronic) |
G89.4 - Chronic pain syndrome |
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R52 - Pain, unspecified |
G56.40 - Causalgia of unspecified upper limb |
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G56.41 - Causalgia of right upper limb |
G56.42 - Causalgia of left upper limb |
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G56.43 - Causalgia of bilateral upper limbs |
57.70 - Causalgia of unspecified lower limb |
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G57.71 - Causalgia of right lower limb |
G57.72 - Causalgia of left lower limb |
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G57.73 - Causalgia of bilateral lower limbs |
G90.50 - Complex regional pain syndrome I, unspecified |
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G90.511 - Complex regional pain syndrome I of right upper limb |
G90.512 - Complex regional pain syndrome I of left upper limb |
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G90.513 - Complex regional pain syndrome I of upper limb, bilateral |
G90.521 - Complex regional pain syndrome I of right lower limb |
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G90.522 - Complex regional pain syndrome I of left lower limb |
G90.523 - Complex regional pain syndrome I of lower limb, bilateral |
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G90.529 - Complex regional pain syndrome I of unspecified lower limb |
G90.59 - Complex regional pain syndrome I of other specified site |
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K14.6 - Glossodynia |
M25.50 - Pain in unspecified joint |
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M25.511 - Pain in right shoulder |
M25.512 - Pain in left shoulder |
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M25.519 - Pain in unspecified shoulder |
M25.521 - Pain in right elbow |
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M25.522 - Pain in left elbow |
M25.529 - Pain in unspecified elbow |
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M25.531 - Pain in right wrist |
M25.532 - Pain in left wrist |
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M25.539 - Pain in unspecified wrist |
M25.541 - Pain in joints of right hand |
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M25.542 - Pain in joints of left hand |
M25.549 - Pain in joints of unspecified hand |
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M25.551 - Pain in right hip |
M25.552 - Pain in left hip |
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M25.559 - Pain in unspecified hip |
M25.561 - Pain in right knee |
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M25.562 - Pain in left knee |
M25.569 - Pain in unspecified knee |
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M25.571 - Pain in right ankle and joints of right foot |
M25.572 - Pain in left ankle and joints of left foot |
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M25.579 - Pain in unspecified ankle and joints of unspecified foot |
M54.2 - Cervicalgia |
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M54.30 - Sciatica, unspecified side |
M54.31 - Sciatica, right side |
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M54.32 - Sciatica, left side |
M54.40 - Lumbago with sciatica, unspecified side |
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M54.41 - Lumbago with sciatica, right side |
M54.42 - Lumbago with sciatica, left side |
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M54.5 - Low back pain |
M54.6 - Pain in thoracic spine |
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M54.9 - Dorsalgia, unspecified |
M77.40 - Metatarsalgia, unspecified foot |
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M77.41 - Metatarsalgia, right foot |
M77.42 - Metatarsalgia, left foot |
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M79.601 - Pain in right arm |
M79.602 - Pain in left arm |
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M79.603 - Pain in arm, unspecified |
M79.604 - Pain in right leg |
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M79.605 - Pain in left leg |
M79.606 - Pain in leg, unspecified |
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M79.609 - Pain in unspecified limb |
M79.676 - Pain in unspecified toe(s) |
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M79.621 - Pain in right upper arm |
M79.622 - Pain in left upper arm |
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M79.629 - Pain in unspecified upper arm |
M79.631 - Pain in right forearm |
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M79.632 - Pain in left forearm |
M79.639 - Pain in unspecified forearm |
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M79.641 - Pain in right hand |
M79.642 - Pain in left hand |
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M79.643 - Pain in unspecified hand |
M79.644 - Pain in right finger(s) |
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M79.645 - Pain in left finger(s) |
M79.646 - Pain in unspecified finger(s) |
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M79.651 - Pain in right thigh |
M79.652 - Pain in left thigh |
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M79.659 - Pain in unspecified thigh |
M79.661 - Pain in right lower leg |
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M79.662 - Pain in left lower leg |
M79.669 - Pain in unspecified lower leg |
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M79.671 - Pain in right foot |
M79.672 - Pain in left foot |
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M79.673 - Pain in unspecified foot |
M79.674 - Pain in right toe(s) |
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M79.675 - Pain in left toe(s) |
M79.676 - Pain in unspecified toe(s) |
- Providers must bill with HCPCS code: J3490 - Unclassified drugs
- One Medicaid and NC Health Choice unit of coverage is: 30 mg
- The maximum reimbursement rate per unit is: $101.52
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDC is: 71518-0001-01
- 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 PADP, refer to the PADP Clinical Coverage Policy 1B, Attachment A, H.7 on Medicaid's website
- Providers shall bill their usual and customary charge for non-340B drugs
- PADP reimburses for drugs billed for Medicaid and Health Choice beneficiaries by 340B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is reflective of their acquisition cost. Providers shall indicate that a drug was purchased under a 340B purchasing agreement by appending the "UD" modifier on the drug detail
- The fee schedule for the PADP is available on Medicaid's PADP web page
Contact
NCTracks Contact Center: 800-688-6696