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Provider Notice issued 02/04/14
Billing Changes to Dispensing Fee Add-on for Certain Birth Control Methods
| To: | Participating Advanced Practice Nurses, Local Health Departments, Physicians and Fee-For-Service Hospitals |
| Date: | February 4, 2014 |
| Re: | Billing Changes to Dispensing Fee Add-on for Certain Birth Control Methods |
The purpose of this notice is to provide corrected information regarding the procedure for billing of the dispensing fee add-on that is applied to very effective birth control methods purchased through the federal 340B Drug Pricing Program.
In order to receive the $20 dispensing fee add-on, providers must identify 340B purchased drugs by reporting modifier "UD" in conjunction with the appropriate procedure code. Effective immediately, the provider charge should be the actual acquisition cost plus the $20 dispensing fee.
Providers who billed in accordance with the April 24, 2013, Informational Notice, Dispensing Fee Add-on for Certain Birth Control Methods, and did not add the $20 dispensing fee in the provider charge did not receive the dispensing fee. In order to receive the correct payment for the 340B drug with dispensing fee, providers should submit an adjustment to void the previous payment and re-bill a single charge including the actual acquisition cost plus $20 dispensing fee. This may be completed electronically by submitting a Bill Type "7" Replacement of a Prior Claim or by submitting a paper HFS 2292 NIPS Adjustment, which can be requested through the Medical Forms Request webpage, form to void the previous payment and awaiting the remittance advice report that the Void has been completed, then submitting a paper replacement claim. Paper claims that are past 180 days from the date of service must be sent to the attention of the 2360 Billing Consultant for timely filing override.
The department will work with providers on an individual basis as needed to ensure that claims where the dispensing fee was not added are properly adjusted retroactive to July 1, 2012.
Product codes and the dates they are eligible for the $20 dispensing fee:
| HCPCS | Birth Control Method | Eligible Dates |
|---|---|---|
| J1050 | Injection, medroxyprogesterone acetate for contraceptive use |
1/1/2013 and after |
| J1055 | Injection, medroxyprogesterone acetate for contraceptive use |
7/1/2012-12/31/2012 |
| J3490 | Levonorgestrel-releasing Intrauterine Device 13.5mg Skyla (must include the name of the item in the note/description field) |
2/11/2013– 12/31/2013 |
| J7300 | Copper Intrauterine Device |
7/1/2012 and after |
| J7301 | Levonorgestrel-releasing Intrauterine Device 13.5mg (Skyla) |
1/1/2014 and after |
| J7302 | Levonorgestrel-releasing Intrauterine Device, 52mg |
7/1/2012 and after |
| J7303 | Vaginal ring |
7/1/2012 and after |
| J7304 | Contraceptive Patch |
7/1/2012 and after |
| J7307 | Etonogestrel Implant |
7/1/2012 and after |
| J8499 | Emergency Contraception when not billable as S4993 (must include the name of the item in the note/description field) |
7/1/2012 and after |
| Q0090 | Levonorgestrel-releasing Intrauterine Device 13.5mg (Skyla) |
7/1/2013-12/31/2013 |
| S4993 | Oral contraceptives, including emergency contraceptive pills |
7/1/2012 and after |
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services, formerly the Bureau of Comprehensive Health Services, at 1-877-782-5565.
Theresa A. Eagleson, Administrator
Division of Medical Programs