Injectables

Physicians and their staff are often confused about Health New England’s reimbursement policy for injectable medications. Part of that confusion relates to HNE's decision not to fully adopt the Health Care Financing Administration Common Procedure Coding System (H.C.P.C.S.) and the codes for injectables. HNE only uses J codes for chemotherapeutic agents, certain vaccines and cytokinesis. Therefore, HNE can not recognize a J code for the purpose of adjudicating a claim.

Another area of confusion arises when HNE uses an intermediary for certain expensive injectables. Providers recently received communication from us about Remicade (infliximab), which detailed how physicians could order the drug through our intermediary NovaFactor. We may use intermediaries when drugs for injections are too expensive for providers to stock.

HNE generally reimburses for injectable drugs at rates negotiated through PHO contracts and consistent with market pressures. If you have a question about which injectables are subject to J code classification or how to file a claim for an injectable, please contact your HNE provider representative at 413-787-4004.