Sutimlimab-jome Injection, for Intravenous Use (Enjaymo™) HCPCS Code J3590: Billing Guidelines Medicaid and NC Health Choice programs cover sutimlimab-jome injection, for intravenous use
Effective with date of service March 16, 2022, the Medicaid and NC Health Choice programs cover sutimlimab-jome injection, for intravenous use (Enjaymo™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
Strength/Package Size: Injection: 1,100 mg/22 mL (50 mg/mL) in a single-dose vial
Indicated to decrease the need for red blood cell (RBC) transfusion due to hemolysis in adults with cold agglutinin disease (CAD).
Recommended Dose: Weight-based dosage weekly for two weeks then every two weeks:
- For patients weighing 39 kg to less than 75 kg: 6,500 mg by intravenous infusion.
- For patients weighing 75 kg or more: 7,500 mg by intravenous infusion.
See full prescribing information for further detail.
For Medicaid and NC Health Choice Billing
- The ICD-10-CM diagnosis code required for billing is: D59.12 - Cold autoimmune hemolytic anemia
- Providers must bill with HCPCS code: J3590 - Unclassified biologics
- One Medicaid and NC Health Choice unit of coverage is: 1 mg
- The maximum reimbursement rate per unit is: $1.77
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDC is:80203-0347-01
- 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.
NCTracks Call Center: 800-688-6696