Billing for naloxone distributed in an emergency department

Washington State Health Care Authority sent this bulletin at 01/25/2022 03:47 PM PST

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Billing for naloxone distributed in an emergency department

Effective January 1 2022, hospital emergency departments (EDs) may distribute prepackaged opioid overdose reversal medication, naloxone, to individuals at risk of an opioid overdose.

For naloxone distributed to Apple Health Fee-For-Service (FFS) clients in the ED, bill as a separate line item with one of the following HCPCS and the National Drug Code (NDC) of the product distributed:

HCPCS	Drug
J2310	Naloxone injection
J3490	Naloxone 4mg nasal spray
G1028	Naloxone 8mg nasal spray

This information will be added to the Outpatient Hospital Services Billing Guide no later than February 15, 2022.

*Note: Reimbursement for naloxone will not be included in the ED bundled rate.

Questions

For questions, please email HCA.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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