New York State Medicaid Fee-for-Service Practitioner Administered Drug Policies and Billing Guidance
Medicaid Fee-for-Service
New York State Medicaid fee-for-service (FFS) program policies and billing guidance for practitioner administered drugs (PADs) are available at:
- Provider Manuals
- Medicine, Drugs and Drug Administration (See section: DRUGS ADMINISTERED OTHER THAN ORAL METHOD)
The table below includes links to guidance for specific practitioner administered drugs or drug classes. Some drugs or drug classes have corresponding Practitioner Administered Drug Clinical Criteria Worksheets.
Providers will submit claims, including the Clinical Criteria Worksheet where applicable, using the Medical Assistance Health Insurance Claim Form New York State eMedNY-150003 with the following:
- Healthcare Common Procedure Coding System (HCPCS) code for the drug.
- The associated National Drug Code (NDC.)
- A copy of the invoice dated within six months prior to the date of service and/or should include the expiration date of the drug.
New York State Medicaid General Professional Billing Guidelines document for claim submission guidance, including the address for submitting a claim form.
The address for submitting a claim form is:
eMedNYP.O. Box 4601
Rensselaer, NY 12144-4601
Expedited/Priority Shipping:
327 Columbia TurnpikeATTN: Box 4601
Rensselaer, NY 12144
Billing Questions, please contact the eMedNY Call Center at 1-800-343-9000.
Drug or Drug Class Name | Policy/Guidance | Clinical Criteria Worksheet Fillable PDF* File |
---|---|---|
AbobotulinumtoxinA (Dysport®) | October 2022 November 2022 |
Dysport (PDF) |
Betibeglogene autotemcel (Zynteglo ®) | January 2024 | Zynteglo (PDF) |
Chimeric Antigen Receptor (CAR) T-cell Therapy | October 2021 | N/A** |
Duchenne Muscular Dystrophy (DMD) | January 2022 | DMD (PDF) |
Elivaldogene autotemecel (Skysona® | December 2023 | Skysona PDF |
Esketamine (Spravato®) Nasal Spray | August 2022 | Spravato (PDF) |
Etranacogene dezaparvovec-drlb (Hemgenix® | December 2023 | Hemgenix PDF |
Goserlin implant (Zoladex ®) | March 2022 | Zoladex (PDF) |
IncobotulinumtoxinA (Xeomin ®) | October 2022 November 2022 |
Xeomin (PDF) |
Infliximab products | October 2022 March 2023 |
Infliximab (PDF) |
Nusinersen (Spinraza®) | March 2023 | Spinraza (PDF) |
OnabotulinumtoxinA (Botox®) | October 2022 November 2022 |
Botox (PDF) |
Onasemenogene aberparvovec-xioi (Zolgensma ®) | November 2019 | Zolgensma (PDF) |
RimabotulinumtoxinB (Myobloc ®) | October 2022 November 2022 |
Myobloc (PDF) |
Vedolizumab (Entyvio®) | October 2022 March 2023 |
Entyvio (PDF) |
Viscosupplementation with Hyaluronan or Derivative | April 2022 | Viscosupplementation (PDF) |
Voretigine neparvovec-rzyl (Luxturna™) | Luxturna (PDF) | N/A** |
* PDF - Portable Document Format
** N/A - Not Applicable