NC Medicaid will now cover, effective for dates of service from Jan. 16, 2024, and limited to FDA authorization for importation, the following presentations of imported benzathine benzylpenicillin (Extencilline) for use in outpatient medical drug claims when billed with HCPCS code J0561 - Injection, penicillin g benzathine, 100,000 units and at outpatient pharmacy (point-of-sale).
This new coverage is being added to address the ongoing shortages of Bicillin® L-A (penicillin G benzathine injectable suspension). NC Medicaid coverage of imported Extencilline will end when the shortage has resolved. This applies to NC Medicaid Direct and NC Medicaid Managed Care.
The FDA has provided Extencilline distribution and administration information in a letter to healthcare providers. Please note that the preparation and administration of Extencilline and the contraindications for prescribing differ from those for Bicillin® L-A. Benzathine benzylpenicillin is another name for Penicillin G benzathine. Extencilline will only be available by prescription in the United States.
Strength/Package Sizes: NC Medicaid covers approved lots and batches only.
- 1,200,000 units: Extencilline, (benzathine benzylpenicillin) Powder and diluent for reconstitution for injection, 1,200,000 units
- 2,400,000 units: Extencilline, (benzathine benzylpenicillin) Powder and diluent for reconstitution for injection, 2,400,000 units
This coverage for Extencilline 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, increasing Bicillin® L-A rates and a public education campaign.
For Medicaid Billing
- For medical claims:
- Providers must bill the product with HCPCS code: J0561 - Injection, penicillin g benzathine, 100,000 units.
- One Medicaid unit of coverage is 100,000 units.
- Providers must bill 11-digit NDCs and appropriate NDC units and appropriate NDC units. The NDCs are 81284-0521-01 and 81284-0522-01.
- 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 NC Medicaid's website.
- The fee schedule for the PADP is available on the NC Medicaid Fee Schedule & Covered Code portal.
- For pharmacy claims, Extencilline is payable for dates of service effective Jan. 16, 2024 . Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are 81284-0521-01 and 81284-0522-01. Please refer to Outpatient Pharmacy Clinical Coverage Policy 9 for additional information.
Contact
NCTracks Call Center: 800-688-6696