Risankizumab Injection, for Intravenous Use (Skyrizi®) HCPCS Code J3590: Billing Guidelines
Effective June 22, 2022, Medicaid and NC Health Choice cover Risankizumab-rzaa Injection, for intravenous use (Skyrizi).

Effective June 22, 2022, Medicaid and NC Health Choice cover Risankizumab-rzaa Injection, for intravenous use (Skyrizi).

Effective with date of service, June 22, 2022, the Medicaid and NC Health Choice programs covers Risankizumab-rzaa Injection, for intravenous use (Skyrizi) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590.

Risankizumab is available as an Intravenous infusion: Injection: 600 mg/10 mL (60 mg/mL) in each single-dose vial.

Risankizumab Injection is indicated for the treatment of moderately to severely active Crohn's disease in adults.

The recommended dose of Risankizumab is Crohn’s Disease: The recommended induction dosage is 600 mg administered by intravenous infusion over at least one hour at Week 0, Week 4, and Week 8.

See full prescribing information for further detail.

For Medicaid and NC Health Choice Billing

  • The ICD-10-CM diagnosis codes required for billing are: 
    • K50.00 - Crohn's disease of small intestine without complications;
    • K50.011 - Crohn's disease of small intestine with rectal bleeding; 
    • K50.012 - Crohn's disease of small intestine with intestinal obstruction; 
    • K50.013 - Crohn's disease of small intestine with fistula; 
    • K50.014 - Crohn's disease of small intestine with abscess; 
    • K50.018 - Crohn's disease of small intestine with other complication; 
    • K50.10 - Crohn's disease of large intestine without complications;
    • K50.111 - Crohn's disease of large intestine with rectal bleeding; 
    • K50.112 - Crohn's disease of large intestine with intestinal obstruction; 
    • K50.113 - Crohn's disease of large intestine with fistula;
    • K50.114 - Crohn's disease of large intestine with abscess; 
    • K50.118 - Crohn's disease of large intestine with other complication; 
    • K50.80 - Crohn's disease of both small and large intestine without complications;
    • K50.811 - Crohn's disease of both small and large intestine with rectal bleeding;
    • K50.812 - Crohn's disease of both small and large intestine with intestinal obstruction; 
    • K50.813 - Crohn's disease of both small and large intestine with fistula; 
    • K50.814 - Crohn's disease of both small and large intestine with abscess;
    • K50.818 - Crohn's disease of both small and large intestine with other complication
  • Providers must bill with HCPCS code: J3590 
  • One Medicaid and NC Health Choice unit of coverage is: 1 mg 
  • The maximum reimbursement rate per unit is: $16.44
  • Providers must bill 11-digit NDCs and appropriate NDC units. The NDC is: 00074-5015-01
  • 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.

Contact

NCTracks Call Center: 800-688-6696

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