NC Medicaid will temporarily cover, effective for dates of service from Aug. 1, 2025, and limited to Food and Drug Administration (FDA) authorization for importation, the following presentations of imported benzathine benzylpenicillin (Extencilline®) and imported benzathine benzylpenicillin tetrahydrate (Lentocilin) 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).
Temporary coverage is being added to address the supply shortage of Bicillin® L-A (penicillin G benzathine injectable suspension) due to a product recall. NC Medicaid coverage of imported Extencilline® and Lentocilin will end when the product shortage has resolved. This applies to NC Medicaid Direct and NC Medicaid Managed Care.
The FDA recognizes this recall could cause challenges procuring enough Bicillin® L-A to meet providers’ needs. Extencilline® and Lentocilin are approved by the FDA for temporary importation due to product shortages. Please note that the preparation, administration and contraindications of Extencilline® and Lentocilin differ from those for Bicillin® L-A. A prescription is required for Extencilline® and Lentocilin 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.
- 1,200,000 units: Lentocilin S (Benzathine Benzylpenicillin Tetrahydrate) Powder and diluent for suspension for injection, 1,200,000 units
For Medicaid Billing
- For Extencilline® medical claims:
- Providers must bill the product with Healthcare Common Procedure Coding System (HCPCS) code: J0561 - Injection, penicillin g benzathine, 100,000 units.
- One Medicaid unit of coverage is 100,000 units.
- Providers must bill 11-digit National Drug Code (NDC) 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 Physician Administered Drug Program (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 Aug. 1, 2025. 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.
- For Lentocilin 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 is 84383-0110-01.
- 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, Lentocilin is payable for dates of service effective Aug. 1, 2025. Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are 84383-0110-01. Please refer to Outpatient Pharmacy Clinical Coverage Policy 9 for additional information.
Contact
NCTracks Call Center: 1-800-688-6696