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Quarterly Update to Injectable Medication Fee Schedule: Q3 2021

Horizon BCBSNJ will update our fee schedule for injectable medications on August 1, 2021. Effective August 1, 2021, 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 changes made each quarter 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 Final Rate Prior Rate Source
C9071 Injection, viltolarsen, 10 mg $57.17 $57.53  
J0178 Injection, aflibercept, 1 mg $941.86 $944.58  
J0207 Injection, amifostine, 500 mg $1,092.84 $1,232.12 AWP-15%
J0222 Injection, patisiran, 0.1 mg $92.60 $92.73  
J0223 Injection, givosiran, 0.5 mg $106.48 $106.58  
J0584 Injection, burosumab-twza, 1 mg $344.57 $344.59  
J1303 Injection, ravulizumab-cwvz, 10 mg $214.68 $214.78  
J1447 Injection, tbo-filgrastim, 1 microgram $0.61 $0.63  
J1566 Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg $69.67 $72.66  
J1572 Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg $39.14 $39.99  
J2405 Injection, ondansetron hydrochloride, per 1 mg $0.26 $0.28  
J2469 Injection, palonosetron hcl, 25 mcg $2.66 $3.06  
J2778 Injection, ranibizumab, 0.1 mg $324.59 $334.58  
J2780 Injection, ranitidine hydrochloride, 25 mg $6.09 $6.64 AWP-15%
J7331 Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg $17.34 $19.55 AWP-15%
J9023 Injection, avelumab, 10 mg $81.64 $82.06  
J9032 Injection, belinostat, 10 mg $40.69 $40.78  
J9039 Injection, blinatumomab, 1 microgram $111.82 $112.54  
J9043 Injection, cabazitaxel, 1 mg $181.81 $182.55  
J9119 Injection, cemiplimab-rwlc, 1 mg $26.33 $26.34  
J9171 Injection, docetaxel, 1 mg $0.64 $0.73  
J9198 Injection, gemcitabine hydrochloride, (infugem), 100 mg $36.79 $38.76 ASP+15%
J9229 Injection, inotuzumab ozogamicin, 0.1 mg $2,225.60 $2,225.79  
J9229 Injection, inotuzumab ozogamicin, 0.1 mg $2,225.60 $2,225.79  
J9264 Injection, paclitaxel protein-bound particles, 1 mg $12.91 $12.99  
J9308 Injection, ramucirumab, 5 mg $61.40 $61.67  
Q4173 Palingen or palingen xplus, per square centimeter $227.64 $280.45 ASP+15%
Q4174 Palingen or promatrx, 0.36 mg per 0.25 cc $316.00 $1,361.70 ASP+15%
Q5101 Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram $0.50 $0.54  
Q9960 High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml $0.12 $0.30 AWP-15%

Claims processed on and after August 1, 2021, 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 August 1, 2021 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: April 30, 2021, 16:59 p.m. ET
Last updated on: April 26, 2021, 18:10 p.m. ET