Effective with date of service March 7, 2023, the Medicaid and NC Health Choice programs cover aprepitant injectable emulsion, for intravenous use (Aponvie™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Strength/Package Size: Injectable emulsion: 32 mg/4.4 mL (7.2 mg/mL) in single-dose vial.
Indicated for the prevention of postoperative nausea and vomiting (PONV) in adults.
Limitations of Use: Aponvie™ has not been studied for treatment of established nausea and vomiting.
Recommended Dose: 32 mg administered as a 30 second intravenous injection prior to induction of anesthesia. See full prescribing information for further detail.
For Medicaid and NC Health Choice Billing
- ICD-10-CM Diagnosis Codes Required for Billing:
- K91.0 - Vomiting following gastrointestinal surgery;
- R11.0 - Nausea;
- R11.11 - Vomiting without nausea;
- R11.12 - Projectile vomiting;
- R11.13 - Vomiting of fecal matter;
- R11.14 - Bilious vomiting;
- T41.0X5A - Adverse effect of inhaled anesthetics, initial encounter;
- T41.0X5D - Adverse effect of inhaled anesthetics, subsequent encounter;
- T41.0X5S - Adverse effect of inhaled anesthetics, sequela
- Providers must bill with HCPCS code: J3490 - Unclassified drugs
- One Medicaid and NC Health Choice unit of coverage is: 1 mg
- The maximum reimbursement rate per unit is: $1.95750
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are: 47426-0401-01, 47426-0401-10
- The NDC units should be reported as "UN1."
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update.
- For additional information regarding NDC claim requirements related to the PADP, refer to the PADP Clinical Coverage Policy 1B, Attachment A, H.7 on DHB'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 the NC Medicaid Fee Schedule & Covered Code portal.
Contact
NCTracks Call Center: 800-688-6696