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Injectable Medication Fee Schedule Update: July 2019

On January 29, 2019, Horizon Blue Cross Blue Shield of New Jersey announced changes to our fee schedule for injectable medications that will be implemented on May 1, 2019.

Effective July 22, 2019, the additional change identified in the table below will be implemented.

Code Dose Final Rate Prior Rate
J0638 1 mg $120.41 $105.78

We update our injectable medication fee schedule each quarter, usually reflecting industry-wide changes to the Average Sales Price (ASP) or the Average Wholesale Price (AWP) of an injectable medication. The listed rates do not reflect industry-wide changes in the ASP/AWP of these medications.

Claims processed on and after July 22, 2019 that include the injectable medication above will be reimbursed based on our revised fee schedule information. Horizon BCBSNJ reserves the right to adjust claims for services provided on and after July 22, 2019 that are not reimbursed according to this updated information.

ASP information for Medicare Part B drugs is posted by the Centers for Medicare & Medicaid Services on the first day of the quarter. AWP information, based on data obtained from manufacturers, distributors and other suppliers, is available from a variety of commercial sources.

Fee Schedule Inquiry Tool

The complete injectable medication fee schedule information is available on our Fee Schedule Inquiry tool. Changes to our injectable medication fee schedule information are accessible on and after the effective date of a quarterly update.

To access, log into, select Horizon BCBSNJ from the My Health Plans menu and:

  • Mouse over Claim Management
  • Select Fee Request Inquiry

To view allowances for specific injectable medications or other services:

  • Select your Billing Provider number, County and Specialty
  • Enter the desired CPT® and/or HCPCS codes
  • Select Submit

CPT® is a registered mark of the American Medical Association.

Published on: April 22, 2019, 10:55 a.m. ET
Last updated on: April 27, 2021, 02:02 a.m. ET