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Quarterly Update to Injectable Medication Fee Schedule: Q1 2018

Horizon Blue Cross Blue Shield of New Jersey will update our fee schedule for injectable medications on February 1, 2018.

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 February 1, 2018. 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 $68.92 $78.90
J0178 1 mg $994.42 $998.01
J1447 1 mcg $0.86 $0.89
J1561 500 mg $44.18 $46.13
J1568 500 mg $41.82 $42.49
J1626 100 mcg $1.39 $1.49
J2430 30 mg $58.24 $63.34
J2503 0.3 mg $838.18 $1,145.00
J2778 0.1 mg $386.94 $389.33
J9032 10 mg $33.70 $33.76
J9042 1 mg $134.76 $135.11
J9171 1 mg $1.90 $2.05
J9267 1 mg $0.24 $0.26
J9308 5 mg $56.84 $56.86
Q5101 1 mcg $0.83 $0.85

The reimbursement of injectable medications included in claims processed on and after February 1, 2018 will be reimbursed based on our revised fee schedule information. Horizon BCBSNJ reserves the right to adjust claims for services provided on and after February 1, 2018 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, 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: October 31, 2017, 09:55 a.m. ET
Last updated on: October 31, 2017, 09:56 a.m. ET