Advanced Notification of Billing Change for Pen Needles

September 1, 2020

Effective for dates of service on or after January 1, 2021, pen needles will no longer be reimbursable when billed on a CMS-1500 claim form using HCPCS code A4215 (needle, sterile, any size, each), submitted to the Department of Health Care Services (DHCS) Fiscal Intermediary (FI). Instead, pen needles, when used in conjunction with injection pens to deliver injectable medications, are to be billed on a pharmacy claim form using the contracted product’s National Drug Code (NDC).

This change only applies to pen needles. Medical supply benefits and billing policy for conventional, filter and safety sterile needles (excluding pen needles) will still be billed on a CMS-1500 claim form using HCPCS code A4215, product UPN, and UPN qualifier, for Medi-Cal fee-for-service (FFS) beneficiaries.

For beneficiaries in Medi-Cal Managed Care Plans (MCP), sterile needles (excluding pen needles) are not carved out from managed care to FFS, therefore the beneficiary’s MCP is responsible for providing sterile needles (excluding pen needles) as a benefit.

As a reminder, as of January 1, 2021, Medi-Cal pharmacy claims will be processed by the new Medi-Cal pharmacy vendor. Please refer to the upcoming bulletins for additional information.