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Elizabeth M. Whitehorn, Director

Provider Notice issued 02/03/09

To: Participating Hospitals:  Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Renal Dialysis Facilities

Date: February 3, 2009

Re: Update of Covered Renal Dialysis Injectable Drugs Effective January 1, 2009
 

The department currently allows an add-on payment for certain injectable drugs billed on institutional outpatient renal dialysis claims (Category of Service 25).  This notice identifies changes the department has made to injectable drug coverage. These changes do not affect the State Renal Program.

In the future, the department will not send a formal notice to announce a renal dialysis drug coverage update. A renal dialysis covered drugs fee schedule has been placed on the department’s Web site. Providers that are registered to receive notification when new information is posted to the Web site will be informed electronically when new listings are available. Providers wishing to receive E-mail notification, when new provider information has been posted by the department, may register for notification on the HFS Web site.

Providers are reminded that any code that has been determined obsolete by the CPT or HCPCS coding systems will not be payable, even if the department experiences a delay in updating the fee schedule on the Web site.

Effective with dates of service on and after January 1, 2009, the department will provide reimbursement for the following reactivated Healthcare Common Procedure Coding System (HCPCS) injectable drug code:

 

J1750 – Injection, Iron Dextran, 50 mg.

 

Effective with dates of service on and after January 1, 2009, the following HCPCS injectable drug code is obsolete and will no longer be reimbursable:

 

Q4098 – Injection, Iron Dextran, 50 mg.

 

NDC Reporting Reminder

 

All of the current injectable drugs identified in the renal dialysis covered drugs fee schedule, 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. 

Providers must report the NDC exactly as instructed in the April 8, 2008 notice. If a claim is billed incorrectly, and that results in non-payment of the add-on for the injectable drug, the claim must be voided and rebilled correctly.

The NDC notice cross-references a renal dialysis injectable drug bulletin dated February 14, 2006, to identify the drugs that must be reported. However, the updated list of injectable drugs shown on the fee schedule supersedes the injectable drug list contained in both the February 14, 2006, bulletin and a subsequent bulletin dated June 11, 2008.

Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.


Theresa A. Eagleson, Administrator
Division of Medical Programs