Outpatient Prospective Payment System and Outpatient Hospitals fee schedule update


 

 

Dear Provider:

 

Effective for claims with dates of service on and after December 14, 2015, Washington Apple Health (Medicaid) administered by the Health Care Authority (the Agency) requires prior authorization for HCPC injection code J2357,Omalizumab 150 mg vial (NDC 50242-0040-62) when billing for outpatient hospital services.

The agency will update the Outpatient Prospective Payment System (OPPS) and Outpatient Hospitals fee schedule to reflect this prior authorization requirement for HCPC code J2357.