Effective with date of service March 29, 2022, the Medicaid and NC Health Choice programs cover hepatitis b vaccine (recombinant) injectable suspension, for intramuscular use (PreHevbrio™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 90759 - Hepatitis B vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg dosage, 3 dose schedule, for intramuscular use.
Strength/Package Size: PreHevbrio™ is an injectable suspension, for intramuscular use supplied as a single-dose vial. A single dose of PreHevbrio™ is 1.0 mL (10 mcg).
Indicated for prevention of infection caused by all known subtypes of hepatitis B virus in adults 18 years of age and older.
Recommended Dose: Administer a series of three doses (1.0 mL each) of PreHevbrio on a 0-, 1- and 6-month schedule. See full prescribing information for further detail.
For Medicaid and NC Health Choice Billing
- The ICD-10-CM diagnosis code required for billing is: Z23 - Encounter for immunization
- Providers must bill with HCPCS code: 90759 - Hepatitis B vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg dosage, 3 dose schedule, for intramuscular use
- One Medicaid and NC Health Choice unit of coverage is: 10 mcg
- The maximum reimbursement rate per unit is: $66.69
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are:75052-0001-01, 75052-0001-10
- The NDC units should be reported as “UN1”
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update and 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 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 Medicaid's PADP web page.
Contact
NCTracks Contact Center: 800-688-6696