As part of a larger effort to address rising rates of syphilis, including congenital syphilis, rates for Bicillin® L-A, Healthcare Common Procedure Coding System (HCPCS) Code J0561, increased as part of the recent changes NC Medicaid made to the Physician Administered Drug Program (PADP) fee schedule. This applies to NC Medicaid Managed Care and NC Medicaid Direct.
The rate for Bicillin® L-A increased effective Feb. 1, 2024, for drugs administered in the physician’s office (as part of the PADP program). The rate increase reflects updated costs of the medication. Bicillin® L-A is a drug which can be used to treat syphilis and the only known effective treatment for preventing congenital syphilis. For more information on the PADP fee schedule change, please see the NC Medicaid to Revise the PADP Fee Schedule bulletin.
For more information on the PADP, please see the NC Medicaid Physician Administered Drug Program webpage. For the PADP fee schedule, please see Fee Schedules and select “Physician Administered Drug Program” from the Program or Fee Schedule drop down boxes and click “Apply Filters”.
This change to the reimbursement for Bicillin® L-A follows other actions by the NC Department of Health and Human Services (NCDHHS), including joining other southeastern states in partnership to combat the surge in congenital syphilis infections, establishing a provider resource webpage and a public education campaign.
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