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Medical Injectables Program Update: Coding for Khapzory

We recently announced that Khapzory™ (levoleucoforin sodium) and other medical injectable drugs will be subject to medical necessity and appropriateness review (MNAR) for services to be provided November 1, 2019 and after as part of our Medical Injectables Program (MIP) administered by Magellan Rx Management℠

Based on guidance recently received from the Centers for Medicare & Medicaid Services (CMS), please use HCPCS code J0642 when submitting claims/information for Khapzory™ (levoleucoforin sodium) for services provided on and after November 1, 2019.

Brand Name Generic Name HCPCS CODE
Khapzory™ levoleucoforin sodium J0642

Magellan Rx Management conducts medical necessity and appropriateness reviews for injectable medications that are administered in a freestanding or hospital-based dialysis center, an outpatient facility, a patient’s home or a physician’s office.¹

Visit our Medical Injectables Program page for more information about this program, including a complete list of the injectable medications that require MNAR.

¹ Medical necessity and appropriateness review is not required for injectable medications that are administered during an inpatient stay, or in an Emergency Room setting or Observation Room setting.

For medical injectable services rendered in the patient’s home in New Jersey, providers should call Horizon Care@Home at 1-855-243-3321 to coordinate the services.

Khapzory™ is a trademark of Spectrum Pharmaceuticals, Inc.
Magellan Rx Management℠ is a service mark of Magellan Health, Inc.

Published on: October 29, 2019, 13:58 p.m. ET
Last updated on: June 2, 2021, 14:42 p.m. ET