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Services
Provider Notice issued 10/25/10
Addition of HCPCS Codes to the Expensive Drugs and Devices (EDD) Listing
| To: | Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers, and Health Information Management Directors; and Ambulatory Surgical Treatment Centers (ASTCs) |
| Date: | October 25, 2010 |
| Re: | Addition of HCPCS Codes to the Expensive Drugs and Devices (EDD) Listing |
Hospitals and ASTCs are eligible for additional payment termed an “outlier payment” for specified expensive drugs and devices provided in conjunction with a procedure from the Ambulatory Procedures Listing (APL). Effective with dates of service beginning September 1, 2010, and after, the following 25 HCPCS codes have been added to the existing EDD Listing and will be considered for an outpatient outlier payment:
| Code | Item |
|---|---|
| J0129 | Injection, Abatacept, 10 mg. |
| J0585 | Injection, Onabotulinumtoxina, 1 unit |
| J0586 | Injection, Abobotulinumtoxina, 5 units |
| J0587 | Injection, Rimabotulinumtoxinb, 100 units |
| J0850 | Injection, Cytomegalovirus Immune Globulin Intravenous (Human), Per Vial |
| J1300 | Injection, Eculizumab, 10 mg. |
| J1561 | Injection, Immune Globulin, (Gamunex), Intravenous, Non-lyophilized (e.g., Liquid), 500 mg. |
| J1562 | Injection, Immune Globulin (Vivaglobin), 100 mg. |
| J1566 | Injection, Immune Globulin, Intravenous, Lyophilized (e.g., powder), Not Otherwise Specified |
| J1568 | Injection, Immune Globulin (Octagam), Intravenous, Non-lyophilized (e.g., Liquid), 500 mg. |
| J1569 | Injection, Immune Globulin (Gammagard Liquid), Intravenous, Non-lyophilized, (e.g., Liquid), 500 mg. |
| J7185 | Injection, Factor VIII (Antihemophilic Factor, Recombinant) (Xyntha), Per I.U. |
| J7186 | Injection, Antihemophilic Factor VIII/Von Willebrand Factor Complex (Human), Per I.U. |
| J7187 | Injection, Von Willebrand Factor Complex (Humate-P), Per IU VWF:RCO |
| J7189 | Factor VIIa (Antihemophilic Factor, Recombinant), Per 1 Microgram |
| J7190 | Factor VIII (Antihemophilic Factor (Human)) Per I.U. |
| J7191 | Factor VIII (Antihemophilic Factor (Porcine)), Per I.U. |
| J7192 | Factor VIII (Antihemophilic Factor, Recombinant) Per I.U., Not Otherwise Specified |
| J7193 | Factor IX (Antihemophilic Factor, Purified, Non-Recombinant) Per I.U. |
| J7194 | Factor IX, Complex, Per I.U. |
| J7195 | Factor IX (Antihemophilic Factor, Recombinant) Per I.U. |
| J7197 | Antithrombin III, (Human), Per I.U. |
| J7198 | Anti-Inhibitor, Per I.U. |
| J7199 | Hemophilia Clotting Factor, Not Otherwise Classified |
| L8690 | Auditory Osseointegrated Device, Includes All Internal and External Components |
Prior Approval
Three codes, J0585, J0586, and J0587 will require prior authorization. Requests for these drugs will be routed through the department's Pharmacy Program. Providers must utilize the HFS 3082 (pdf), Drug Prior Authorization Request Form, available on the department's Web site.
The additional HCPCS codes have been included in the latest Expensive Drugs and Devices Listing, located on the department's Web site. The EDD Listing provides a link to the HFS 3082 Drug Prior Authorization Form, and also identifies the APL codes that must be billed in conjunction with the HCPCS codes.
The Handbook for Hospital Services, Topic H-270.7 – Expensive Drugs and Devices, will be updated to identify the HFS 3082 Drug Prior Authorization Request Form for drug prior approvals. Refer to the Handbook for Hospital Services, Appendix H-2b, for outpatient billing instructions including appropriate National Drug Code (NDC) reporting.
Any questions regarding this notice may be directed to your UB-04 billing consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.
Theresa A. Eagleson, Administrator
Division of Medical Programs