Quarterly Update to Injectable Medication Fee Schedule: Q3 2017
Horizon Blue Cross Blue Shield of New Jersey will update our fee schedule for injectable medications on August 1, 2017.
We update our injectable medication fee schedule each quarter, usually reflecting industry-wide changes to the Average Sales Price (ASP) or the Average Wholesale Price (AWP) of an injectable medication.
The table below identifies decreases in injectable medication fee amounts effective August 1, 2017. The listed rates do not reflect industry-wide changes in the ASP/AWP of the medications in question.
| Code | Dose | Final Rate | Prior Rate | |
|---|---|---|---|---|
| 90281 | 2 ml | $77.54 | $77.78 | |
| J0178 | 1 mg | $999.66 | $999.89 | |
| J1447 | 1 mcg | $0.78 | $0.84 | |
| J1459 | 500 mg | $43.62 | $44.28 | |
| J1561 | 500 mg | $45.44 | $45.53 | |
| J1569 | 500 mg | $47.59 | $48.30 | |
| J2260 | 5 mg | $2.69 | $3.46 | |
| J2778 | 0.1 mg | $383.97 | $388.70 | |
| J9032 | 10 mg | $32.94 | $33.06 | |
| J9042 | 1 mg | $129.83 | $130.10 | |
| J9308 | 5 mg | $56.59 | $56.70 | |
| Q0180 | 100 mg | $97.42 | $109.83 | |
| Q4104 | 1 sq cm | $33.74 | $47.97 | |
| Q4105 | 1 sq cm | $39.93 | $43.59 | |
| Q4108 | 1 sq cm | $30.10 | $49.34 | |
| Q4110 | 1 sq cm | $54.30 | $54.72 | |
| Q5101 | 1 mcg | $0.87 | $0.90 |
The reimbursement of injectable medications included in claims processed on and after August 1, 2017 will be reimbursed based on our revised fee schedule information. Horizon BCBSNJ reserves the right to adjust claims for services provided on and after August 1, 2017 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 online 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 Submit
CPT® is a registered mark of the American Medical Association.