Effective with date of service June 21, 2022, the Medicaid and NC Health Choice programs cover Vutrisiran injection, for subcutaneous use (Amvuttra) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Vutrisiran is available as a single-dose prefilled syringes to provide 25 mg/0.5 mL.
Vutrisiran is indicated for the treatment of the polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults.
The recommended dose of Vutrisiran is 25 mg administered by subcutaneous injection once every three 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: E85.1 - Neuropathic heredofamilial amyloidosis
- Providers must bill with HCPCS code: J3490
- One Medicaid and NC Health Choice unit of coverage is:1 mg
- The maximum reimbursement rate per unit is: $5,005.80
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDC is:71336-1003-01
- 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