Belantamab Mafodotin-blmf for injection, for Intravenous use (Blenrep™) HCPCS Code J9999: Billing Guidelines

Tuesday, October 13, 2020

Effective with date of service Aug. 6, 2020, the Medicaid and NC Health Choice programs cover belantamab mafodotin-blmf for injection, for intravenous use (Blenrep™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Strength/Package Size:  For injection: 100 mg as a lyophilized powder in a single-dose vial for reconstitution and further dilution.

Indicated for the treatment of adult patients with relapsed or refractory multiple myeloma who have received at least 4 prior therapies including an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent.

Recommended Dose:  2.5 mg/kg as an intravenous infusion over approximately 30 minutes once every 3 weeks.  See full prescribing information for further detail.

For Medicaid and NC Health Choice Billing

  • The ICD-10-CM diagnosis code(s) required for billing are: C90.00 - Multiple myeloma not having achieved remission;
  •  C90.02 - Multiple myeloma in relapse
  • Providers must bill with HCPCS code: J9999 - Not otherwise classified, antineoplastic drugs
  • One Medicaid and NC Health Choice unit of coverage is: 1 mg
  • The maximum reimbursement rate per unit is: $89.39
  • Providers must bill 11-digit NDCs and appropriate NDC units. The NDC(s) is/are: 00173-0896-01
  • 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 NC Medicaid's website.
  • Providers shall bill their usual and customary charge for non-340B drugs.
  • PADP reimburses for drugs billed for Medicaid and NC 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 DHB's PADP web page.

Contact
NCTracks Contact Center: 800-688-6696