New York State Medicaid Fee-for-Service Practitioner Administered Drug Policies and Billing Guidance

The following links contain information for providers participating in the New York State Medicaid fee-for-service (FFS) program on policies and billing guidance for practitioner administered drugs:

• Provider Manuals
• Medicine, Drugs and Drug Administration (See section: DRUGS ADMINISTERED OTHER THAN ORAL METHOD)
• Drug specific policies (as issued in Medicaid Update articles):
  • Axicabtagene ciloleucel (Yescarta™)
  • Crizanlizumab-tmca (Adakveo®)
  • Onasemenogene aberparvovec-xioi (Zolgensma®)
  • Tisagenlecleucel (Kymriah™)
  • Voretigine neparvovec-rzyl (Luxturna™)

Medicaid Managed Care (MMC) plan policies and billing guidance for practitioner administered drugs can be found at the MMC Pharmacy Benefit Information Center. Select a plan and then the link to practitioner administered drug policy and billing guidance.

Policy Updates

Updates to the practitioner administered drug payment polices are in the Medicaid Update, which is published monthly. The Medicaid Update Main Page has topics arranged alphabetically and contains search functionality.

Provider Communications

Periodically, communications are posted on the eMedNY website.This link to the Provider Manual Tab will lead to a web page with listed practitioner groups.Within many practitioner groups, the right-hand panel will have a "Featured Links" section that contains a link to that group's "communications."

Questions:

• FFS policy questions may be directed to the Office of Health Insurance Programs (OHIP) Division of Program Development and Management at (518) 473‑2160.
• FFS billing and claim questions should be directed to the eMedNY call center at (800) 343‑9000.
• MMC reimbursement, billing, and/or documentation questions should be directed to the enrollee's MMC plan.