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NDC Billing Requirement Update Effective December 1, 2022

Audience: Participating Prescribing Providers

To ensure that your claims are submitted accurately, and to allow for timely processing and correct reimbursement, please review the claim billing requirements effective December 1, 2022, for the following drugs:

HCPCS Code

Description

J3262

Actemra, injection, tocilizumab, 1 mg

Q0249

Actemra, injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg

J9035

Avastin, injection, bevacizumab, 10 mg

C9257

Avastin, injection, bevacizumab, 0.25 mg

J0179

Beovu, injection, brolucizumab-dbll, 1 mg

J1786

Cerzyme, injection, imiglucerase, 10 units

J0717

Cimzia, injection, certolizumab pegol, 1 mg

J2786

Cinqair, injection, reslizumab, 1 mg

J3060

Elelyso, injection, taliglucerase alfa, 10 units

J1438

Enbrel, injection, etanercept, 25 mg

J3380

Entyvio, injection, vedolizumab, 1 mg

J0885

Procrit / Epogen, injection, epoetin alfa, (for non-ESRD use), 1000 units

Q4081

Procrit / Epogen, injection, epoetin alfa, 100 units (for ESRD on dialysis) (for renal dialysis facilities and hospital use)

J0178

Eylea, injection, aflibercept, 1 mg

J0517

Fasenra, injection, benralizumab, 1 mg

Q5108

Fulphila, injection, pegfilgrastim-jmdb, biosimilar, 0.5 mg

90651

Gardasil, Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use

J0257

Glassia, injection, alpha 1 proteinase inhibitor (human), 10 mg

J9355

Herceptin, injection, trastuzumab, excludes biosimilar, 10 mg

J9356

Herceptin Hylecta, injection, trastuzumab, 10 mg and Hyaluronidase-oysk

Q5113

Herzuma, injection, trastuzumab-pkrb, biosimilar, 10 mg

J0135

Humira, injection, adalimumab, 20 mg

J3245

Ilumya, injection, tildrakizumab, 1 mg

Q5117

Kanjinti, injection, trastuzumab-anns, biosimilar, 10 mg

J7296

Kyleena, levonorgestrel-releasing intrauterine contraceptive system, 19.5 mg

J0202

Lemtrada, injection, alemtuzumab, 1 mg

J7297

Liletta, levonorgestrel-releasing intrauterine contraceptive system, 52 mg

J2778

Lucentis, injection, ranibizumab, 0.1 mg

J3398

Luxturna, injection, voretigene neparvovec-rzyl, 1 billion vector genomes

J2503

Macugen, injection, pegaptanib sodium, 0.3 mg

J1726

Makena, injection, hydroxyprogesterone caproate, 10 mg

J7298

Mirena, levonorgestrel-releasing intrauterine contraceptive system, 52 mg

J9293

Mitoxantrone, injection, mitoxantrone hydrochloride, per 5 mg

Q5107

MVASI, injection, bevacizumab-awwb, biosimilar, 10 mg

J2506

Neulasta, injection, pegfilgrastim, excludes biosimilar, 0.5 mg

J2796

Nplate, injection, romiplostim, 10 micrograms

J2182

Nucala, injection, mepolizumab, 1 mg

Q5122

Nyvepria, injection, pegfilgrastim-apgf, biosimilar, 0.5 mg

J2350

Ocrevus, injection, ocrelizumab, 1 mg

Q5114

Ogivri, injection, Trastuzumab-dkst, biosimilar, 10 mg

J0222

Onpattro, injection, Patisiran, 0.1 mg

Q5112

Ontruzant, injection, trastuzumab-dttb, biosimilar, 10 mg

J0129

Orencia, injection, abatacept, 10 mg

J7300

Paragard, intrauterine copper contraceptive

J1745

Injection, infliximab, excludes biosimilar, 10 mg

J3285

Remodulin / Treprostinil Injection, treprostinil, 1 mg

Q5105

Retacrit, injection, epoetin alfa-epbx, biosimilar, (for esrd on dialysis), 100 units

Q5106

Retacrit Injection, epoetin alfa-epbx, biosimilar, (for non-esrd use), 1000 units

Q5123

Riabni, injection, rituximab-arrx, biosimilar, 10 mg

J9312

Rituxan, injection, rituximab, 10 mg

J9311

Rituxan, injection, rituximab 10 mg and hyaluronidase

Q5119

Ruxience, injection, rituximab-pvvr, biosimilar, 10 mg

J2353

Sandostatin LAR, injection, octreotide, depot form for intramuscular injection, 1 mg

J2502

Signifor LAR Injection, pasireotide long acting, 1 mg

J1602

Simponi, injection, golimumab, 1 mg, for intravenous use

J7301

Skyla, levonorgestrel-releasing intrauterine contraceptive system, 13.5 mg

J1300

Soliris, injection, eculizumab, 10 mg

J1930

Somatuline Depot, injection, lanreotide, 1 mg

J2326

Spinraza, injection, nusinersen, 0.1 mg

J2779

Susvimo, injection, ranibizumab, via intravitreal implant, 0.1 mg

C9093

Susvimo, injection, ranibizumab, via sustained release intravitreal implant, 0.1 mg

J2356

Tezspire, injection, tezepelumab-ekko, 1 mg

Q5116

Trazimera, injection, trastuzumab-qyyp, biosimilar, 10 mg

J1628

Tremfya, injection, guselkumab, 1 mg

Q5115

Truxima, injection, rituximab-abbs, biosimilar, 10 mg

J2323

Tysabri, injection, natalizumab, 1 mg

Q5111

Udenyca, injection, Pegfilgrastim-cbqv, biosimilar, 0.5 mg

J1303

Ultomiris, injection, ravulizumab-cwvz, 10 mg

J1823

Uplizna, injection, inebilizumab-cdon, 1 mg

C9097

Vabysmo, inj, faricimab-svoa, 0.1 mg

J1325

Veletri / Flolan / Epoprostenol, injection, epoprostenol, 0.5 mg

J3385

Vpriv, injection, velaglucerase alfa, 100 units

J9332

Vyvgart, injection, efgartigimod alfa-fcab, 2mg

J2357

Xolair, injection, omalizumab, 5 mg

Q5120

Ziextenzo, injection, pegfilgrastim-bmez, biosimilar, 0.5 mg

Q5118

Zirabev, injection, bevacizumab-bvzr, biosimilar, 10 mg

J3399

Zolgensma, injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes

 

  • Prior to submitting claims for these medications, and as a best practice, please confirm that they are submitted with a drug code that includes:
    • Valid National Drug Code (NDC) in 11-digit format  
    • Number of NDC units administered
    • Valid unit of measure
  • New York state continues to require that all Medicaid Managed Care and Child Health Plus claims include NDC information for drugs billed by a provider when administered in an office or facility.

Reminders:

  • In addition to the New York State billing requirements noted above, we consider it a best practice for submission of the NDC information (valid 11-digit NDC, unit of measure and number of units) for all plans for drugs billed by a provider when administered in an office or outpatient setting to be considered for reimbursement.  
  • Drugs purchased under the 340B program must also be submitted with a "UD" procedure code modifier (indicating a 340B purchased drug).
  • Please note that failure to follow the enclosed instructions will result in denied claims for Medicaid plans and potential delays in reimbursement for claims under other plans.

We ask that you share this important information with your billing office/billing service and anyone within your practice who should be aware.

If you have questions or concerns, please contact your Provider Relations representative.

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