Wiki Anthem Blue Cross

[daedolos]

Does anybody know where to find some documentation for current pricing for an injectable drug? Specifically, I'm trying to find the "allowable amount" for monovisc code J7327 and the friendly reps at the 800 number were not very helpful. I'm sure there is some sort of fee schedule for these sorts of things that Blue Cross deals with.

Peace
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I have found the Medicare October ASP Pricing File but I just want to be sure about the exact amount BX is going to pay. Also, I've heard that they are putting out a policy called CG-DRUG-29 that will deem J7327 not medically necessary. Does anybody have any more info on this? Thanks in advance.

 

[lindsey.motter]

Anthem and Hyaluronan Injections in the Knee

Anthem follows the state Medicaid and/or CMS Medicare fee schedules for pricing.

Lindsey Motter,LPN, CPC, CPMA
Clinical Provider II, Special Investigations Unit

 

[Wbeshears]

Anthem no longer finds hyaluronan injections medically necessary