Agencies
Services
Provider Notice issued 06/11/08
Q4098 – Injection, Iron Dextran, 50 mg.
J1751 – Injection, Iron Dextran 165, 50 mg.
J1752 – Injection, Iron Dextran 267, 50 mg.
Update of Covered Renal Dialysis Injectable Drugs
| To: |
Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Renal Dialysis Facilities |
| Date: | June 11, 2008 |
| Re: |
Update of Covered Renal Dialysis Injectable Drugs |
The department currently allows an add-on payment for certain injectable drugs billed on institutional outpatient renal dialysis claims (Category of Service 25). This bulletin identifies changes the department has made to injectable drug coverage. These changes do not affect the State Renal Program.
Effective with dates of service on and after April 1, 2008, the department will provide reimbursement for the following new Healthcare Common Procedure Coding System (HCPCS) injectable drug code:
Effective with dates of service on and after April 1, 2008, the following HCPCS injectable drug codes are obsolete and will no longer be reimbursable:
The covered injectable drug codes are identified in the attached update to the Handbook for Hospitals. The Physician Fee Schedule on the department’s Web site also contains these codes and identifies their rates. Hospitals and renal dialysis facilities need to verify rate information and the maximum dosage allowed for the injectable drugs from the fee schedule. The Physician Fee Schedule is located at: <http://www.illinois.gov/hfs/MedicalProviders/MedicaidReimbursement/Pages/default.aspx>. The department continues to reimburse Erythropoietin billed under revenue codes 634 or 635 with value code 68 at $9.45 per 1,000 units.
NDC Reporting Reminder
All of the current injectable drugs identified in the attached update, in addition to Erythropoietin (Epogen), are subject to NDC reporting on outpatient renal dialysis claims. For additional information, please refer to the informational notice titled, “Reporting of the National Drug Code (NDC) on Outpatient Institutional Claims,” dated April 8, 2008, on the department’s Web site at: <http://www.illinois.gov/hfs/MedicalProviders/hospitals/Pages/default.aspx/>.
The NDC notice cross-references the last renal dialysis injectable drug bulletin dated February 14, 2006, to identify the drugs that must be reported. However, the updated list of injectable drugs associated with this bulletin supersedes the injectable drug list contained in the February 14, 2006, bulletin.
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.illinois.gov/hfs/MedicalProviders/Handbooks/Pages/default.aspx>. Changes to the replacement handbook page are acknowledged by an “=” to the left of the affected text. 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 Healthcare and Family Services
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 January 2006, with the attached revised Page One dated April 2008. Providers may wish to retain the January 2006 page as a reference.