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Quarterly Update to Injectable Medication Fee Schedule: Q2 2019

Horizon BCBSNJ will update our fee schedule for injectable medications on May 1, 2019.

Effective May 1, 2019, the fees for the injectable medications listed in the table below will decrease.

We update our injectable medication fee schedule each quarter. The majority of quarterly changes reflect
industry-wide changes to the Average Sales Price (ASP) or the Average Wholesale Price (AWP) of an injectable medication. The changes noted in the table below identify decreases in injectable medication fees that do not reflect industry-wide changes in the ASP or AWP.

Code Dose Prior Rate Final Rate
J0178 1 mg $987.57 $984.00
J0185¹ 1 mg $2.52 $2.29
J1557 500 mg $56.48 $49.79
J1568 500 mg $39.84 $38.48
J1569 500 mg $46.80 $45.81
J1572 500 mg $38.04 $37.32
J1626 100 mcg $1.16 $1.15
J1627 0.1 mg $3.54 $2.73
J2405 1 mg $1.17 $1.08
J2469 25 mcg $16.33 $14.24
J2778 0.1 mg $382.23 $373.38
J9023 10 mg $78.75 $78.74
J9039 1 mcg $104.62 $104.42
J9171 1 mg $1.54 $1.37
J9271 1 mg $46.85 $46.52
J9299 1 mg $26.14 $26.10
J9308 5 mg $57.91 $57.86
Q2043 Per infusion
(minimum 50 million cells)
$41,452.00 $40,694.33
Q5105 100 units $1.28 $1.24
Q5106 1000 units $12.77 $12.41

¹Change resulting from move to ASP pricing from AWP pricing.

Claims processed on and after May 1, 2019 that include these injectable medications will be reimbursed based on our revised fee schedule information. Horizon BCBSNJ reserves the right to adjust claims for services provided on and after May 1, 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: January 29, 2019, 08:08 a.m. ET
Last updated on: April 26, 2021, 02:26 a.m. ET