Medicaid Bulletin
Remimazolam for Injection, for Intravenous Use (Byfavo™) HCPCS Code J3490: Billing Guidelines
Effective with date of service Jan. 28, 2021, the Medicaid and NC Health Choice programs cover remimazolam for injection, for intravenous use (Byfavo™).
Cabotegravir and Rilpivirine Co-Packaged for IM Use (Cabenuva™) HCPCS Code J3490: Billing Guidelines
Effective with date of service Feb. 1, 2021, the Medicaid and NC Health Choice programs cover cabotegravir extended-release injectable suspension; rilpivirine extended-release injectable suspension, co-packaged for intramuscular use (Cabenuva™).
SPECIAL BULLETIN COVID-19 #161: Billing for Administration of Monoclonal Antibodies
The U.S. Food and Drug Administration has issued an Emergency Use Authorization for the unapproved products, bamlanivimab and etesevimab to be administered together for qualifying patients.
SPECIAL BULLETIN COVID-19 #160: Janssen COVID-19 Vaccine HCPCS Code 91303 and 0031A Billing Guidelines
Janssen COVID-19 vaccine is authorized for use under an Emergency Use Authorization (EUA) for active immunization to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 18 years of age and older.
Rituximab-arrx Injection, for Intravenous Use (Riabni™) HCPCS Code J3590: Billing Guidelines
Effective with date of service Jan 5, 2021, the Medicaid and NC Health Choice programs cover rituximab-arrx injection, for intravenous use (Riabni™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
Lumasiran Injection, for Subcutaneous Use (Oxlumo™) HCPCS Code J3490: Billing Guidelines
Effective with date of service Dec. 22, 2020, the Medicaid and NC Health Choice programs cover lumasiran injection, for subcutaneous use (Oxlumo™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
SPECIAL BULLETIN COVID-19 #148: Pfizer-BioNTech COVID-19 Vaccine (N/A) HCPCS Code 91300: Billing Guidelines
Effective with date of service Dec 12, 2020, the Medicaid and NC Health Choice programs cover Pfizer-BioNTech COVID-19 Vaccine for use in the Physician Administered Drug Program.
[Coagulation Factor VIIa (Recombinant)-jncw] Lyophilized Powder for Solution, for Intravenous Use (Sevenfact®) HCPCS Code J7212: Billing Guidelines
Effective with date of service Jan 1, 2021, the Medicaid and NC Health Choice programs cover [coagulation factor VIIa (recombinant)-jncw] lyophilized powder for solution, for intravenous use (Sevenfact®) for use in the Physician Administered Drug Program.
Pegfilgrastim-apgf Injection, for Subcutaneous Use (Nyvepria™) HCPCS Code Q5122: Billing Guidelines
Effective with date of service Jan 1, 2021, the Medicaid and NC Health Choice programs cover pegfilgrastim-apgf injection, for subcutaneous use (Nyvepria™) for use in the Physician Administered Drug Program.
Ferric Derisomaltose Injection, for Intravenous Use (Monoferric™) HCPCS Code J1437: Billing Guidelines
Effective with date of service Oct. 2, 2020, the Medicaid and NC Health Choice programs cover ferric derisomaltose injection, for intravenous use (Monoferric™) for use in the Physician Administered Drug Program.
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
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