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Elizabeth M. Whitehorn, Director

Provider Notice issued 10/06/03

Updates to Renal Dialysis Injectable Drug Coverage and Rates

 

​To: ​EnrolledHospitals - Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Renal Dialysis Facilities
​Date: ​October 6, 2003
​Re: ​Updates to Renal Dialysis Injectable Drug Coverage and Rates

No.: H200-03-1

 

The department currently allows an add-on payment for certain injectable drugs billed on UB-92 outpatient renal dialysis claims (category of service 25). This bulletin identifies changes the department has made to drug coverage and rates. These changes do not affect the State Renal Program.

 

Effective with dates of service on or after January 1, 2003, the department will provide reimbursement for the following new HCPCS injectable drug codes:

 

  • J2501 - Injection, Paricalcitol, (Zemplar) 1 mcg.
  • J2916 – Injection, Sodium Ferric Gluconate Complex in Sucrose, (Ferrlecit) 12.5 mg.
  • J0636 – Injection, Calcitriol, (Calcijex) 0.1 mcg.

 

Effective with dates of service on or after October 1, 2003, the following HCPCS injectable drug codes are obsolete and will no longer be reimbursable:

 

  • J0635 – Injection, Calcitriol, (Calcijex) 1 mcg.
  • J2500 – Injection, Paricalcitol, (Zemplar) 5 mcg.
  • J2915 – Injection, Sodium Ferric Gluconate Complex in Sucrose, (Ferrlecit) 62.5 mg/5 cc
  • J1755 – Injection, Iron Sucrose, (Venofer) 20 mg/cc
  • W0237 – Injection, Paricalcitol, (Zemplar) 1 mcg.

As with other covered injectable drugs, providers must utilize revenue code 636 (Drugs Requiring Detailed Coding) in Form Locator 42 of the UB-92 to denote the drug revenue line, and indicate the HCPCS code in Form Locator 44. These new codes and corresponding rates are identified in the attached table.

 

This bulletin and replacement page for the Handbook for Hospitals referencing the drug coverage changes are available on the department's Web site at <http://www.dpaillinois.com/releases/>. Since the department revised coverage or rate information for every drug identified in the table, these revisions are acknowledged by a single "=" to the left of the title line in the table. Please note that the Handbook for Hospitals is not currently available on the Web site.

 

Paper copies of the replacement page, as well as an entire handbook, may be obtained by written request. To ensure delivery, you must specify a physical street address when requesting a paper copy. You may submit your written request to the address below, or fax or e-mail it as noted:

 

Illinois Department of Public Aid
Provider Participation Unit
Post Office Box 19114
Springfield, Illinois 62794-9114
Fax Number: 217-557-8800 / E-Mail Address: hfs.webmaster@illinois.gov

Instructions for updating the Handbook for Hospitals:

Replace page one of Appendix H-18 dated July 2002 with the attached revised page one dated September 2003. Providers may wish to retain the July 2002 page as a reference.

 

Appendix H-18 (1) Renal Dialysis Injectable Drug HCPCS Codes and Payment Schedule (pdf)