Effective with date of service, March 6, 2023, the Medicaid and NC Health Choice programs cover flortaucipir F 18 injection for intravenous use (Tauvid) for use in the Physician’s Administered Drug Program (PADP) when billed with HCPCS code A9601 - Flortaucipir f 18 injection, diagnostic, 1 millicurie.
Strength/Package Size: Injection: 300 MBq/mL to 1,900 MBq/mL (8.1 mCi/mL to 51 mCi/mL) of flortaucipir F 18 injection in a multiple-dose vial.
Indicated for positron emission tomography (PET) imaging of the brain to estimate the density and distribution of aggregated tau neurofibrillary tangles (NFTs) in adult patients with cognitive impairment who are being evaluated for Alzheimer’s disease (AD).
The recommended dose is 370 MBq (10 mCi), administered as a bolus intravenous injection. See full prescribing information for further detail.
For Medicaid and NC Health Choice Billing
- Providers must bill the product with HCPCS code: A9601 - Flortaucipir f 18 injection, diagnostic, 1 millicurie.
- The billing is for patient-ready dose vial only.
- Providers must indicate the number of HCPCS units.
- One Medicaid and Health Choice unit of coverage is: 1 millicurie
- The maximum reimbursement rate per unit is: $378.52000
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDC is: 00002-1210-01.
- The NDC units should be reported as "UN1."
- The fee schedule for the PADP is available on NC Medicaid's PADP web page.
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update and 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