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Correction to Reimbursement Rate for Hydroxyprogesterone Caproate

April 10, 2018

The Department of Health Care Services (DHCS) is aware of a discrepancy in the reimbursement for HCPCS code J1726 (injection, hydroxyprogesterone caproate [Makena], 10 mg). The current reimbursement rate is $7.52 per billing unit, which includes the $4.46 injection administration fee for the first billing unit. This reimbursement rate is incorrect.

Effective for dates of service on or after January 1, 2018, the corrected reimbursement rate for code J1726 is $36.58 per billing unit, which includes the $4.46 injection administration fee paid on the first billing unit. No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.