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Updated: HCPCS Codes to Specialty Medication Administration Site of Care Policy, Effective Jan. 1, 2021

November 23, 2020

The Specialty Medication Administration Site of Care Policy, effective March 15, 2020, will be updated to add these HCPCS codes: J0791, Q5121, J0584, J3060, J0223, J0638, J3245, J3397, J0222, J3241, J1746, J1303, J3032 and J1558.

An updated RX501.096 Medical Policy will be posted prior to Jan. 1, 2021 to assist providers in determining when to apply benefit preauthorization requirements for these codes.

As always, it is critical to check eligibility and benefits first, prior to rendering care and services, to confirm coverage, network status and other important details.

Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been preauthorized/pre-notified for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. Regardless of benefits, the final decision about any medication is between the member and their health care provider. If you have questions, contact the number on the member’s ID card.