Injectable Medication Fees to be Updated: July 1, 2021
Horizon BCBSNJ will make changes to our fee schedule for certain injectable medications on July 1, 2021. Effective July 1, 2021, the fees for the injectable medications listed in the table below will decrease as noted.
The changes noted in the table below identify decreases in injectable medication fees that do not reflect industry-wide changes in the Average Sales Price (ASP).
|Code||Description||Final Rate||Prior Rate||Source|
|J0885||Injection, epoetin alfa, (for non-esrd use), 1000 units||$9.16||$9.57||ASP+10%|
|J9035||Injection, bevacizumab, 10 mg||$75.16||$77.99||ASP+6%|
|J9311||Injection, rituximab 10 mg and hyaluronidase||$40.23||$41.75||ASP+6%|
|J9312||Injection, rituximab, 10 mg||$91.26||$94.71||ASP+6%|
|J9355||Injection, trastuzumab, excludes biosimilar, 10 mg||$97.92||$101.62||ASP+6%|
|J9356||Injection, trastuzumab, 10 mg and hyaluronidase-oysk||$74.59||$80.92||ASP+6%|
|Q4081||Injection, epoetin alfa, 100 units (for esrd on dialysis)||$0.92||$0.96||ASP+10%|
|Q5105||Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units||$0.89||$0.93|
|Q5106||Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units||$8.90||$9.31|
|Q5107||Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg||$58.87||$61.55||ASP+10%|
|Q5112||Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg||$88.17||$95.65||ASP+6%|
|Q5113||Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg||$86.43||$93.76||ASP+6%|
|Q5114||Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg||$75.82||$79.27||ASP+10%|
|Q5115||Injection, rituximab-abbs, biosimilar, (truxima), 10 mg||$71.08||$74.31||ASP+10%|
|Q5116||Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg||$76.82||$80.31||ASP+10%|
|Q5118||Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg||$61.72||$64.52||ASP+10%|
|Q5120||Injection, pegfilgrastim-bmez, biosimilar, (ziextenzo), 0.5 mg||$297.96||$309.21||ASP+6%|
|Q5121||Injection, infliximab-axxq, biosimilar, (avsola), 10 mg||$53.28||$55.70||ASP+10%|
Claims processed on and after July 1, 2021 that include these injectable medications will be reimbursed based on this revised fee schedule information. Horizon BCBSNJ reserves the right to adjust claims for services provided on and after July 1, 2021 that are not reimbursed according to this updated information.
The changes noted in the table above, which are being made outside of our regularly scheduled quarterly updates, identify decreases determined by Horizon BCBSNJ.These changes do not reflect industry-wide changes in the Average Sales Price (ASP) or the Average Wholesale Price (AWP) of these medications.
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 NaviNet.net, 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 CPT® is a registered mark of the American Medical Association.