Author: CSRA 1-800-688-6696
Effective with date of service Oct. 23, 2017, the N.C. Medicaid and N.C. Health Choice (NCHC) programs cover meropenem and vaborbactam for injection, for intravenous use (Vabomere) for use in the Physician's Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs. Vabomere 2 grams for injection is supplied as a sterile powder for constitution in single-dose vials containing meropenem 1 gram (equivalent to 1.14 grams of meropenem trihydrate) and vaborbactam 1 gram.
Vabomere is indicated for the treatment of patients 18 years and older with complicated urinary tract infections (cUTI) including pyelonephritis caused by designated susceptible bacteria. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Vabomere and other antibacterial drugs, Vabomere should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.
The recommended dose for Vabomere is 4 grams (meropenem 2 grams and vaborbactam 2 grams) every eight hours by intravenous infusion for up to 14 days. See full prescribing information for further detail.
For Medicaid and NCHC Billing
- The ICD-10-CM diagnosis codes required for billing are:
- N10 - Acute pyelonephritis;
- N11.0 - Nonobstructive reflux-associated chronic pyelonephritis;
- N11.1 - Chronic obstructive pyelonephritis;
- N11.8 - Other chronic tubulo-interstitial nephritis;
- N11.9 - Chronic tubulo-interstitial nephritis, unspecified;
- N12 - Tubulo-interstitial nephritis, not specified as acute or chronic;
- N13.6 - Pyonephrosis;
- N16 - Renal tubulo-interstitial disorders in diseases classified elsewhere;
- N30.00 - Acute cystitis without hematuria;
- N30.01 - Acute cystitis with hematuria;
- N30.20 - Other chronic cystitis without hematuria;
- N30.21 - Other chronic cystitis with hematuria;
- N30.80 - Other cystitis without hematuria;
- N30.81 - Other cystitis with hematuria;
- N30.90 - Cystitis, unspecified without hematuria;
- N30.91 - Cystitis, unspecified with hematuria;
- N34.0 - Urethral abscess;
- N34.1 - Nonspecific urethritis;
- N34.2 - Other urethritis;
- N39.0 - Urinary tract infection, site not specified
- B96.1 - Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases classified elsewhere;
- B96.20 - Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere;
- B96.21 - Shiga toxin-producing Escherichia coli [E. coli] (STEC) O157 as the cause of diseases classified elsewhere;
- B96.22 - Other specified Shiga toxin-producing Escherichia coli [E. coli] (STEC) as the cause of diseases classified elsewhere;
- B96.23 - Unspecified Shiga toxin-producing Escherichia coli [E. coli] (STEC) as the cause of diseases classified elsewhere;
- B96.29 - Other Escherichia coli [E. coli] as the cause of diseases classified elsewhere.
- Providers must bill with HCPCS code: J3490 - Unclassified drugs.
- One Medicaid unit of coverage is1 vial. NCHC bills according to Medicaid units.
- The maximum reimbursement rate per unit is $178.20.
- Providers must bill 11-digit National Drug Codes (NDCs) and appropriate NDC units. The NDCs is/are: 65293-0009-01, 65293-0009-06.
- The NDC units should be reported as “UN1.”
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update.
- For additional information regarding NDC claim requirements related to the PDP, refer to the PDP Clinical Coverage Policy No. 1B, Attachment A, H.7 on the N.C. Medicaid website.
- Providers shall bill their usual and customary charge for non-340B drugs.
- PDP reimburses for drugs billed for Medicaid and NCHC beneficiaries by 340B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is reflective of their acquisition cost. Providers shall indicate that a drug was purchased under a 340B purchasing agreement by appending the "UD" modifier on the drug detail.
- The fee schedule for the Physician's Drug Program is available on N.C. Medicaid’s PDP web page.