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Quarterly Update to Injectable Medication Fee Schedule: Q4 2020

Horizon BCBSNJ will update our fee schedule for injectable medications on November 1, 2020. The fees for the injectable medications listed in the table below will decrease effective November 1, 2020.

We update our injectable medication fee schedule quarterly. 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.¹

Code Dose Final Rate Prior Rate
J0178 1 mg $954.03 $960.32
J0470² 100 mg $54.55 $64.89
J1447 1 mcg $0.65 $0.71
J1557 500 mg $58.08 $59.90
J1568 500 mg $42.27 $43.91
J1626 100 mcg $0.43 $0.44
J1627 0.1 mg $1.01 $1.57
J2430 30 mg $49.49 $53.59
J2503 0.3 mg $830.11 $831.09
J2778 0.1 mg $344.50 $353.88
J2860 10 mg $111.99 $112.46
J9119 1 mg $26.35 $26.36
J9171 1 mg $0.88 $1.06
Q2043 per infusion $45,412.79 $45,760.38
Q5101 1 mcg $0.63 $0.64
Q5105 100 units $0.98 $1.01

The changes noted in the table identify decreases in injectable medication fees that do not reflect industry-wide changes in the ASP or AWP.

² Change resulting from move to AWP pricing from ASP pricing.

Claims processed on and after November 1, 2020 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 November 1, 2020 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 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.

Published on: July 27, 2020, 05:06 a.m. ET
Last updated on: July 21, 2020, 05:16 a.m. ET