Difelikefalin Injection, for Intravenous use (Korsuva™) HCPCS code J0879 - Injection, difelikefalin, 0.1 microgram, (for ESRD on Dialysis): Billing Guidelines Medicaid and NC Health Choice programs cover difelikefalin injection, for intravenous use

Effective with date of service April 1, 2022, the Medicaid and NC Health Choice programs cover difelikefalin injection, for intravenous use (Korsuva™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J0879 - Injection, difelikefalin, 0.1 microgram, (for ESRD on dialysis).

Strength/Package Size: Injection: 65 mcg/1.3 mL (50 mcg/mL) of difelikefalin as a clear, colorless solution in a single-dose glass vial

Indicated for the treatment of moderate-to-severe pruritus associated with chronic kidney disease (CKD-aP) in adults undergoing hemodialysis (HD).

Limitation of Use: Korsuva™ has not been studied in patients on peritoneal dialysis and is not recommended for use in this population.

Recommended Dose: 0.5 mcg/kg administered by intravenous bolus injection into the venous line of the dialysis circuit at the end of each HD treatment. See full prescribing information for further detail.

For Medicaid and NC Health Choice Billing

• The ICD-10-CM diagnosis code required for billing is: L29.8 - Other pruritus
• Providers must bill with HCPCS code: J0879 - Injection, difelikefalin, 0.1 microgram, (for ESRD on dialysis)
• One Medicaid and Health Choice unit of coverage is: 0.1 mcg 
• The maximum reimbursement rate per unit is: $0.25
• Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are: 59353-0065-01, 59353-0065-12
• 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 Call Center: 800-688-6696