How do I bill for take-home naloxone?

Washington State Health Care Authority sent this bulletin at 04/15/2022 03:00 PM PDT

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How do I bill for take-home naloxone?

In response to the increase in opioid overdose-related deaths in Washington State, the legislature passed Senate Bill 5195 (chapter 273, Laws of 2021). This law helps to increase access to naloxone for all individuals at risk of an opioid overdose. The law requires distribution of prepackaged (take-home) naloxone to individuals at risk of an opioid overdose at:

Hospital emergency departments (EDs)
Pharmacies
Opioid treatment programs
Certified or licensed behavioral health agencies (BHAs) that provide any of the following services:
- Treatment for mental health or substance use disorders
- Secure withdrawal management
- Evaluation and treatment

Retroactive to dates of service on and after January 1, 2022, hospital EDs, opioid treatment programs and certified or licensed BHAs may be reimbursed for prepackaged opioid overdose reversal medication, naloxone, distributed to clients at risk of an opioid overdose. Naloxone distributed to Apple Health Fee-For-Service (FFS) clients may be billed with one of the following HCPCS and the National Drug Code (NDC) of the product distributed:

HCPCS	Drug
J2310	Naloxone injection
G2215	Naloxone 4mg nasal spray
G1028	Naloxone 8mg nasal spray

Note:

When provided in the ED, take-home naloxone must be billed as a separate line item. HCA does not package naloxone when provided in the ED.
When provided by a Behavioral Health Agency, take-home naloxone must be billed as a separate claim.

See the Prescription Drug Program Billing Guide for more information.

For questions, please email us at AppleHealthPharmacyPolicy@hca.wa.gov.

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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