Effective with date of service April 4, 2023, the NC Medicaid program covers velmanase alfa-tycv for injection, for intravenous use (Lamzede) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
Strength/Package Size: For injection: 10 mg of velmanase alfa-tycv as a lyophilized powder in a single-dose vial for reconstitution.
Indicated for the treatment of non-central nervous system manifestations of alpha-mannosidosis in adult and pediatric patients.
The recommended Dose: 1 mg/kg (actual body weight) administered once every week as an intravenous infusion. See full prescribing information for further detail.
For Medicaid Billing
- The ICD-10-CM diagnosis code required for billing is: E77.1 - Defects in glycoprotein degradation
- Providers must bill with HCPCS code: J3590 - Unclassified biologics
- One Medicaid unit of coverage is: 1 mg
- The maximum reimbursement rate per unit is: $432.00000
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are: 10122-0180-01, 10122-0180-02
- 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 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