Home Infusion Therapy Drug Schedules Effective 9/1/11

Reimbursement Changes/Updates

Note: The Drug/Injectable Fee Schedule will be updated on the following dates: 9/1/2011, 12/1/2011, 3/1/2012 and 6/1/2012.

Codes not listed may require individual consideration (IC) to determine the BCBSTX compensation allowable amount. NDC pricing listed is based on NDC units and should be billed appropriately.

1. Effective March 1, 2012, BCBSTX will temporarily discontinue reimbursing claims submitted with an NDC in accordance with the NDC schedule posted on the website under "Drugs" with the exception of immunizations. Immunizations submitted with an NDC will continue to be reimbursed in accordance with the NDC schedule posted on the website under "Drugs" until July 14, 2012. Drugs other than immunizations submitted with an NDC will be reimbursed in accordance with the schedule posted on the website under "Drugs" based on the applicable Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT^®) code(s) included on the claim. BCBSTX will continue to accept NDC for billing of all physician-administered and physician-supplied drugs.
2. Effective July 15, 2012, immunizations submitted with an NDC will be reimbursed in accordance with the schedule posted on the website under "Drugs" based on the applicable Current Procedural Terminology (CPT^®) code(s) included on the claim. BCBSTX will continue to accept NDC for billing of all physician-administered and physician-supplied drugs, including immunizations.

These services may only be provided to HMO Blue^® Texas Members by the Provider that is contracted with HMO Blue Texas for that purpose.

• J7184
• J7185
• J7186

• J7187
• J7189
• J7190

• J7192
• J7193
• J7194

• J7195
• J7198

CPT/HCPCS/NDC Home Infusion Drug Schedule

NDC / CPT / HCPCS Billable Units