Blue Review
A newsletter for contracting institutional and professional providers

July 2019

Changes to 2019 Specialty Pharmacy Select Infusion Drug List (Commercial)

We have updated our Specialty Pharmacy Infusion Site of Care Benefit Preauthorization Drug List to reflect two new replacement Healthcare Common Procedure Coding System (HCPCS) codes assigned by the Centers for Medicare & Medicaid Services (CMS):

  • Fasenra – changed from C9466 to J0517
  • Radicava – changed from C9493 to J1301

The updated 2019 Specialty Pharmacy Select Infusion Drug List (Commercial) referenced above is available on our Provider website, under the Related Resources on the Prior Authorization page. For the select drugs on this list, you may need to submit a benefit preauthorization request to Blue Cross and Blue Shield of Illinois (BCBSIL) prior to administration of the drug and selection of Infusion Site of Care.

For more information, refer to the Specialty Pharmacy Program page. Also, stay current with BCBSIL’s Medical Policies. You can look up RX501.096 – Specialty Medication Administration Site of Care and other policies by category, title or policy number.

As a reminder, we encourage you to check eligibility and benefits via an electronic 270 transaction through the Availity® Provider Portal or your preferred vendor portal. It’s important to check eligibility and benefits for each patient at every visit to confirm coverage details. This step also may help you identify benefit preauthorization/pre-notification requirements. If you have benefit questions, call the number on the member’s ID card.

This information does not apply to HMO or government programs members.

Trademarks are the property of their respective owners.

Checking eligibility and benefits and/or obtaining benefit preauthorization/pre-notification or predetermination of benefits is not a guarantee that benefits will be paid. Payment is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations and exclusions set forth in your patient’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any benefit determination, the final decision regarding any treatment or service is between you and your patient. If you have any questions, call the number on the member’s ID card.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.