H Alabama Medicaid Injectable Drug List
H Alabama Medicaid Injectable Drug List
H Alabama Medicaid Injectable Drug List
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<strong>Alabama</strong> <strong>Medicaid</strong> Physician <strong>Drug</strong> <strong>List</strong><br />
Pricing of Physician <strong>Drug</strong>s<br />
For Dates of Service prior to July 1, 2005, physician drug prices were updated<br />
semi-annually by EDS. <strong>Medicaid</strong> reimbursement was calculated by averaging<br />
the Average Wholesale Prices (AWP) from the Red Book or 80-95% of DIMA<br />
(<strong>Drug</strong>, Improvement, and Modernization Act).<br />
Effective for Dates of Service July 1, 2005 and thereafter, the <strong>Alabama</strong><br />
<strong>Medicaid</strong> Agency will adopt Medicare’s <strong>Drug</strong> Pricing Methodology using the<br />
Average Sale Price (ASP) for HCPCS injectable drug codes.<br />
H.2 Physician <strong>Drug</strong> <strong>List</strong> by Name<br />
The following table provides a listing of valid physician drug codes sorted<br />
alphabetically by name. To view this list sorted numerically, refer to Section<br />
H.3, Physician <strong>Drug</strong> <strong>List</strong> by Procedure Code.<br />
The inclusion or exclusion of a procedure code on this list does not imply<br />
<strong>Medicaid</strong> coverage, reimbursement, or lack thereof. To inquire regarding any<br />
restrictions/limits on these procedure codes, please consult the Provider<br />
Assistance Center at 1-800-688-7989. The pricing file must be verified to<br />
determine coverage and reimbursement amounts.<br />
The following drugs can be injected subcutaneously, intramuscularly, or<br />
intravenously.<br />
Effective for dates of service July 1, 2004 and thereafter, <strong>Medicaid</strong> will no<br />
longer accept X codes. Please utilize the following crosswalk when billing for<br />
services for which an X code was previously used.<br />
X Code<br />
Replacement HCPCS Code<br />
X-1015 S0016<br />
X1090<br />
S0077<br />
X-1365 J1700<br />
X-1415 J1980<br />
X-1460 J1055<br />
X-1525 J2680<br />
X-1545 J1980<br />
X-1550 J3415<br />
X-1573 J0696<br />
X-1574 J0696<br />
X-1655 J0595<br />
X-1705 J3411<br />
X-1717 J3301<br />
H-10 July 2006