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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.

     

Published on: April 1, 2021, 09:53 a.m. ET
Last updated on: March 31, 2021, 04:33 a.m. ET