Medical Injectables Program Coding Updates
Horizon collaborates with Magellan Rx Management (MRxM) to administer its Medical Injectables Program (MIP). As part of our shared commitment to help ensure that the medications our members need are medically necessary and cost effective, the following changes will be made to our MIP.
New HCPCS Codes
Based on Centers for Medicare & Medicaid Services' (CMS) guidance please use the newly assigned procedure codes when submitting requests/claims for the drugs noted below.
| BRAND NAME | GENERIC NAME | New Code | New Code Effective Date |
|---|---|---|---|
| Vabysmo® | faricimab-svoa | J2777 | October 1, 2022 |
| Kimmtrak® | tebentafusp-tebn | J9274 | October 1, 2022 |
| Releuko® | fligrastim-ayow | Q5125 | October 1, 2022 |
| Enjaymo™ | sutimlimab-jome | J1302 | October 1, 2022 |
If you have any questions, please contact your Network Specialist or Ancillary Contracting Specialist.
Magellan Rx Management℠ is a service mark of Magellan Health, Inc. Magellan Rx Management is an independent company that has contracted with Horizon Blue Cross Blue Shield of New Jersey for the administration of our Medical Injectables Program (MIP). Magellan Rx Management conducts medical necessity and appropriateness review (MNAR) for certain medical injectable drugs. Magellan Rx Management is independent from and not associated with Horizon Blue Cross Blue Shield of New Jersey.
This web page contains prescription brand name drugs that are registered marks or trademarks of pharmaceutical manufacturers that are not affiliated with Magellan Rx Management, Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross Blue Shield Association.