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Empire Blue Cross Blue Shield
Injectable Drug Update |
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Injectable drug update:
The following policy updates will be effective for all claims processed
on or after March 20, 2009, regardless of the date of service. In
addition to current policy the following updates and processing changes
will be applied.
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Palonosetron HCl (J2469)
— Claims reporting diagnosis V58.12 will be reviewed for criteria:
Diagnoses 995.2 and V66.2 will be considered not medically appropriate.
Bortezomib (J9041) — Claims reporting diagnoses 200.20-200.28,
202.80 will be reviewed for criteria.
Pemetrexed Disodium (J9305) — Claims reporting diagnosis 162.0
will be reviewed for criteria.
Rituximab (J9310) — Claims reporting diagnosis 287.4 will be
considered not medically appropriate: 287.4.
Fulvestrant (J9395) — Claims reporting diagnosis 175.0-175.9
will be reviewed for criteria: 175.0-175.9.
Zoledronic acid (Zometa) (J3487) — Claims reporting diagnoses
200.00-202.98, 203.10-203.82, 204.00-208.91 will be reviewed for
criteria. |
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Fee schedules are available, If you need a copy of your fee schedule, you
can fax a request to
the attention of Provider Network Management at 718-312-6240.
MediBlueSM news
Annual benefits changes for Medicare Advantage plan members will be
effective January 1, 2009.
The changes apply to members enrolled in Empire’s MediBlue HMO, MediBlue
PPO and MediBlue Total Solutions plans.
Offices
are encouraged to perform insurance verifications on all MediBlue
patients to clarify prescription benefits, coinsurance and out of pocket
changes.
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You can also obtain fee schedule information on our
Physician Online Services at empireblue.com
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1.Click on the “Physicians” tab and then register or log in.
2. From your homepage, select “Searches”
3.Then “Fee Schedules.”
You can view fees by CPT code and modifier. |
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