Medicaid

Medicaid Alert: All Medicaid Providers - Bevacizumab (Avastin, HCPCS Procedure Code J9035) - Update to Billing Guidelines

This provides new information regarding N.C. Medicaid’s coverage of the drug Avastin for breast carcinoma. The N.C. Medicaid program will discontinue coverage of Avastin for breast carcinoma under the Physician’s Drug Program for recipients who are newly diagnosed and/or beginning treatment for breast carcinoma on and after date of service April 1, 2012, instead of January 1, 2012, as previously communicated in the December 2011 general Medicaid bulletin. Medicaid will also continue to reimburse for Avastin for those recipients who were already receiving Avastin for breast carcinoma prior to date of service April 1, 2012, so their treatment may be completed. Claims paid for Avastin on and after April 1, 2012, for breast carcinoma recipients not already on Avastin treatment prior to April 1, 2012, may be recouped.

Until date of service April 1, 2012, providers may continue to bill for recipients who receive Avastin for breast carcinoma and the other covered diagnoses. Refer to the May 2010 general Medicaid bulletin article for current billing guidelines. Providers should watch for a future bulletin article with detailed billing guidelines regarding billing for breast carcinoma diagnoses on and after April 1, 2012.

HP Enterprise Services, 1-800-688-6696 or 919-851-8888