Effective with date of service March 9, 2021, the North Carolina Medicaid and NC Health Choice programs cover trilaciclib for injection, for intravenous use (Cosela) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Cosela is available for injection: 300 mg of trilaciclib as a lyophilized cake in a single-dose vial. It is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for extensive-stage small cell lung cancer.
Recommended Dose: 240 mg/m2 as a 30-minute intravenous infusion completed within four hours prior to the start of chemotherapy on each day chemotherapy is administered. 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:
- C34.00 - Malignant neoplasm of unspecified main bronchus;
- C34.01 - Malignant neoplasm of right main bronchus;
- C34.02 - Malignant neoplasm of left main bronchus;
- C34.10 - Malignant neoplasm of upper lobe, unspecified bronchus or lung;
- C34.11 - Malignant neoplasm of upper lobe, right bronchus or lung;
- C34.12 - Malignant neoplasm of upper lobe, left bronchus or lung;
- C34.2 - Malignant neoplasm of middle lobe, bronchus or lung;
- C34.30 - Malignant neoplasm of lower lobe, unspecified bronchus or lung;
- C34.31 - Malignant neoplasm of lower lobe, right bronchus or lung;
- C34.32 - Malignant neoplasm of lower lobe, left bronchus or lung;
- C34.80 - Malignant neoplasm of overlapping sites of unspecified bronchus and lung;
- C34.81 - Malignant neoplasm of overlapping sites of right bronchus and lung;
- C34.82 - Malignant neoplasm of overlapping sites of left bronchus and lung;
- C34.90 - Malignant neoplasm of unspecified part of unspecified bronchus or lung;
- C34.91 - Malignant neoplasm of unspecified part of right bronchus or lung;
- C34.92 - Malignant neoplasm of unspecified part of left bronchus or lung;
- T45.1X5A - Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter;
- T45.1XAD - Adverse effect of antineoplastic and immunosuppressive drugs, subsequent encounter;
- T45.1X5S - Adverse effect of antineoplastic and immunosuppressive drugs, sequela.
- 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: $5.10
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs is: 73462-0101-01
- 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 Call Center: 800-688-6696