Effective with date of service Oct. 1, 2022, the Medicaid and NC Health Choice programs cover Ipratropium Bromide/Albuterol Sulfate inhalation solution for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J7620 - Albuterol, up to 2.5 mg and Ipratropium Bromide, up to 0.5 mg, FDA-approved final product, non-compounded, administered through DME.
Strength/Package Size(s): Ipratropium Bromide/Albuterol Sulfate inhalation solution is supplied as a 3-mL sterile solution for nebulization in sterile low-density polyethylene unit-dose vials
FDA Approved Indication: Indicated for the treatment of bronchospasm associated with COPD in patients requiring more than one bronchodilator
Recommended Uses from the National Heart, Lung, and Blood Institute: Asthma exacerbations for children through 12 years of age and adults
Recommended Dose:
FDA Approved Recommended Dose: Treatment of bronchospasm associated with COPD
- 18 years of age and older: The recommended dose of ipratropium bromide/albuterol sulfate inhalation solution is one 3 mL vial administered four times per day via nebulization with up to two additional 3 mL doses allowed per day, if needed. Safety and efficacy of additional doses or increased frequency of administration of ipratropium bromide/albuterol sulfate inhalation solution beyond these guidelines has not been studied and the safety and efficacy of extra doses of albuterol sulfate or ipratropium bromide in addition to the recommended doses of ipratropium bromide/albuterol sulfate inhalation solution have not been studied.
Recommended Doses from the National Heart, Lung, and Blood Institute: Asthma exacerbations
- Child Dose for children through 12 years of age: 1.5-3 mL every 20 minutes for three doses, then as needed
- Adult Dose: 3 mL every 20 minutes for three doses, then as needed
May be used for up to three hours in the initial management of severe exacerbations. The addition of ipratropium to albuterol has not been shown to provide further benefit once the patient is hospitalized.
See full prescribing information for further detail.
For Medicaid and NC Health Choice Billing
The ICD-10-CM diagnosis codes required for billing are:
Bronchospasm associated with COPD:
J41.0 - Simple chronic bronchitis;
J41.1 - Mucopurulent chronic bronchitis;
J41.8 - Mixed simple and mucopurulent chronic bronchitis;
J43.0 - Unilateral pulmonary emphysema [MacLeod's syndrome];
J43.1 - Panlobular emphysema;
J43.2 - Centrilobular emphysema;
J43.8 - Other emphysema;
J44.0 - Chronic obstructive pulmonary disease with (acute) lower respiratory infection;
J44.1 - Chronic obstructive pulmonary disease with (acute) exacerbation
Asthma exacerbations:
J45.20 - Mild intermittent asthma, uncomplicated;
J45.21 - Mild intermittent asthma with (acute) exacerbation;
J45.22 - Mild intermittent asthma with status asthmaticus;
J45.30 - Mild persistent asthma, uncomplicated;
J45.31 - Mild persistent asthma with (acute) exacerbation;
J45.32 - Mild persistent asthma with status asthmaticus;
J45.40 - Moderate persistent asthma, uncomplicated;
J45.41 - Moderate persistent asthma with (acute) exacerbation;
J45.42 - Moderate persistent asthma with status asthmaticus;
J45.50 - Severe persistent asthma, uncomplicated;
J45.51 - Severe persistent asthma with (acute) exacerbation;
J45.52 - Severe persistent asthma with status asthmaticus;
J45.901 - Unspecified asthma with (acute) exacerbation;
J45.902 - Unspecified asthma with status asthmaticus;
J45.909 - Unspecified asthma, uncomplicated;
J45.990 - Exercise induced bronchospasm;
J45.991 - Cough variant asthma;
J45.998 - Other asthma;
J98.01 - Acute bronchospasm
- Providers must bill with HCPCS code: J7620 - Albuterol, up to 2.5 mg and Ipratropium Bromide, up to 0.5 mg, FDA-approved final product, non-compounded, administered through DME
- One Medicaid and NC Health Choice unit of coverage is: 2.5 mg/0.5 mg
- The maximum reimbursement rate per unit is: $0.12700
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are: 00378-9671-30, 00378-9671-31, 00378-9671-60, 00378-9671-64, 00378-9671-93, 00487-0201-00, 00487-0201-01, 00487-0201-03, 00487-0201-60, 47335-0756-48, 47335-0756-49, 47335-0756-52, 60687-0405-79, 60687-0405-83, 69097-0173-48, 69097-0173-53, 69097-0173-64, 69097-0840-34, 69097-0840-53, 69097-0840-64, 69097-0840-87, 76204-0600-01, 76204-0600-05, 76204-0600-12, 76204-0600-30, 76204-0600-60
- 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