Apple Health billing code update for take-home naloxone

Washington State Health Care Authority sent this bulletin at 01/09/2023 05:12 PM PST

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How do I bill for take-home naloxone?

HCA has updated billing codes for take-home naloxone for Apple Health Fee-For-Service (FFS) clients. The codes are 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 as a separate line item with one of the following HCPCS and the National Drug Code (NDC) of the product distributed:

HCPCS	Modifier	Drug
J2310		Naloxone injection
J2311		Naloxone injection, Zimhi
J3490	HG	Naloxone 4mg nasal spray
J3490	TG	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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