Aripiprazole Extended-release Injectable Suspension, for Intramuscular Use (Abilify Asimtufii®) HCPCS Code J3490 - Unclassified Drugs: Billing Guidelines

Effective May 30, 2023, NC Medicaid covers aripiprazole extended-release injectable suspension, for intramuscular use (Abilify Asimtufii).

Effective with date of service May 30, 2023, the NC Medicaid program covers aripiprazole extended-release injectable suspension, for intramuscular use (Abilify Asimtufii) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.

Strength/Package Sizes:

Extended-release injectable suspension: 960 mg/3.2 mL and 720 mg/2.4 mL single-dose pre-filled syringes.

Indicated:

  • for the treatment of schizophrenia in adults
  • as maintenance monotherapy treatment of bipolar I disorder in adults

Recommended Dose:

  • The recommended dosage of Abilify Asimtufii is 960 mg, administered once every 2 months (56 days after previous injection).
  • Patients Receiving Oral Antipsychotics
    • When Abilify Asimtufii injection is initiated in patients receiving oral aripiprazole, administer the first dose of Abilify Asimtufii along with oral aripiprazole (10 mg to 20 mg) for 14 consecutive days.
    • For patients already stable on another oral antipsychotic (and known to tolerate aripiprazole), administer the first Abilify Asimtufii injection along with the oral antipsychotic for 14 consecutive days.
  • Patients Receiving Abilify Maintena
    • For patients receiving Abilify Maintena (once monthly dosing), administer Abilify Asimtufii 960 mg (once every 2 months dosing) in place of the next scheduled injection of the Abilify Maintena.
    • The first Abilify Asimtufii injection may be administered in place of the second or later injection of Abilify Maintena.
  • If there are adverse reactions with the Abilify Asimtufii 960 mg dosage, the dosage may be reduced to 720 mg once every 2 months.

See full prescribing information for further detail.

For Medicaid Billing

  • ICD-10-CM Diagnosis Codes Required for Billing are:
    • Schizophrenia:
      • F20.0 - Paranoid schizophrenia;
      • F20.1 - Disorganized schizophrenia;
      • F20.2 - Catatonic schizophrenia;
      • F20.3 - Undifferentiated schizophrenia;
      • F20.5 - Residual schizophrenia;
      • F20.89 - Other schizophrenia;
    • Bipolar I Disorder:
      • F31.0 - Bipolar disorder, current episode hypomanic;
      • F31.11 - Bipolar disorder, current episode manic without psychotic features, mild;
      • F31.12 - Bipolar disorder, current episode manic without psychotic features, moderate;
      • F31.13 - Bipolar disorder, current episode manic without psychotic features, severe;
      • F31.2 - Bipolar disorder, current episode manic severe with psychotic features;
      • F31.31 - Bipolar disorder, current episode depressed, mild;
      • F31.32 - Bipolar disorder, current episode depressed, moderate;
      • F31.4 - Bipolar disorder, current episode depressed, severe, without psychotic features;
      • F31.5 - Bipolar disorder, current episode depressed, severe, with psychotic features;
      • F31.61 - Bipolar disorder, current episode mixed, mild;
      • F31.62 - Bipolar disorder, current episode mixed, moderate;
      • F31.63 - Bipolar disorder, current episode mixed, severe, without psychotic features;
      • F31.64 - Bipolar disorder, current episode mixed, severe, with psychotic features;
      • F31.71 - Bipolar disorder, in partial remission, most recent episode hypomanic;
      • F31.72 - Bipolar disorder, in full remission, most recent episode hypomanic;
      • F31.73 - Bipolar disorder, in partial remission, most recent episode manic;
      • F31.74 - Bipolar disorder, in full remission, most recent episode manic;
      • F31.75 - Bipolar disorder, in partial remission, most recent episode depressed;
      • F31.76 - Bipolar disorder, in full remission, most recent episode depressed;
      • F31.77 - Bipolar disorder, in partial remission, most recent episode mixed;
      • F31.78 - Bipolar disorder, in full remission, most recent episode mixed;
      • F31.89 - Other bipolar disorder
  • Providers must bill with HCPCS code: J3490 - Unclassified drugs
  • One Medicaid unit of coverage is: 1 mg
  • The maximum reimbursement rate per unit is: $6.11826
  • Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are: 59148-0102-80, 59148-0114-80
  • 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 NC 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 

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