The Health Care Authority (HCA) recently updated information regarding billing of take-home opioid reversal medication pursuant to Senate Bill 5195, enacted during the 2021 legislative session. WSHA has been actively working with HCA to obtain updated information as HCA develops its billing and payment processes. Beginning May 1, hospitals and behavioral health agencies can bill the Medicaid enrollee’s managed care organization for medication provided on or after January 1, 2022. Hospitals should bill codes J2310, J3490, G1028, along with their appropriate NDC codes for take-home opioid reversal medication dispensed in the emergency department. This should be billed as a separate service line on the institutional claim and will be paid in addition to the payment for the emergency service. We recommend hospitals contact the MCOs regarding billing medication provided on or after January 1 if that had not been previously billed or paid as a separate expense with the ED visit. Behavioral health agencies should bill the same codes on a separate professional claim from the billing for the behavioral health service itself. For more information, see page 78 of the Prescription Drug Program Billing Guide and page 14 of the Mental Health Services Billing Guide.
We are awaiting information from HCA on how hospitals and behavioral health providers can bill HCA for opioid reversal medication provided to uninsured patients. (Andrew Busz, AndrewB@wsha.org).
