Effective with date of service Aug. 4, 2020, the Medicaid and NC Health Choice programs cover amisulpride injection, for intravenous use (Barhemsys®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Strength/Package Size(s): Injection: 5 mg/2 mL (2.5 mg/mL) in a single-dose vial.
Indicated in adults for:
- Prevention of postoperative nausea and vomiting (PONV), either alone or in combination with an antiemetic of a different class.
- Treatment of PONV in patients who have received antiemetic prophylaxis with an agent of a different class or have not received prophylaxis.
Recommended Dose (See full prescribing information for further detail):
- Prevention of PONV, either alone or in combination with another antiemetic of a different class: 5 mg as a single intravenous dose infused over one to two minutes at the time of induction of anesthesia.
- Treatment of PONV: 10 mg as a single intravenous dose infused over one to two minutes in the event of nausea and/or vomiting after a surgical procedure.
For Medicaid and NC Health Choice Billing
- The ICD-10-CM diagnosis code(s) required for billing is/are:
- R11.0 - Nausea;
- R11.10 - Vomiting, unspecified;
- R11.11 - Vomiting without nausea;
- R11.12 - Projectile vomiting;
- R11.13 - Vomiting of fecal matter;
- R11.14 - Bilious vomiting;
- R11.2 - Nausea with vomiting, unspecified;
- K91.0 - Vomiting following gastrointestinal surgery
- Providers must bill with HCPCS code: J3490 - Unclassified drugs
- One Medicaid and Health Choice unit of coverage is: 1 mg
- The maximum reimbursement rate per unit is: $9.18
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs is/are: 71390-0125-20, 71390-0125-21
- 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