Effective with date of service April 1, 2022, the Medicaid and NC Health Choice programs cover leuprolide injectable emulsion, for subcutaneous use (Camcevi) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J1952 - Leuprolide injectable, Camcevi™, 1 mg.
Strength/Package Size: Injectable emulsion: 42 mg leuprolide (equivalent to approximately 48 mg leuprolide mesylate) as a sterile, off-white to pale yellow, viscous, and opalescent emulsion in a single-dose, pre-filled syringe for subcutaneous injection
Indicated for the treatment of adult patients with advanced prostate cancer.
Recommended Dose: 42 mg subcutaneously every 6 months (See full prescribing information for further detail).
For Medicaid and NC Health Choice Billing
- The ICD-10-CM diagnosis code required for billing is: C61 - Malignant neoplasm of prostate
- Providers must bill with HCPCS code: J1952 - Leuprolide injectable, camcevi, 1 mg
- One Medicaid and NC Health Choice unit of coverage is: 1 mg
- The maximum reimbursement rate per unit is: $100.29
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDC is: 69448-0014-63
- 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