Provider Update – Special Edition August 2021
Posted on August 30, 2021
We are happy to share with you this Special Edition August 2021 to update you on the Site of Service Program for our Commercial (Fully Insured) Members.
If you have any questions about the information in this notice, please contact Health New England Provider Relations at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.
Site of Service Program for Commercial (Fully Insured) Members – Effective October 1, 2021
Effective October 1, 2021, Health New England will require that the administration of the infusion and injectable therapy medications listed below occur in the patient’s home (place of service 12) for Commercial Fully Insured Members. During the pre-certification process with Magellan Rx Management, we will apply this requirement.
| Procedure Code | Brand Name | Generic Name |
| J3262 | ACTEMRA | tocilizumab |
| J1931 | ALDURAZYME | laronidase |
| J0256/J0257 | ARALAST NP | Alpha-1-proteinase Inhibitor |
| J0490 | BENLYSTA | belimumab |
| J0597 | BERINERT | C1 esterase inhibitor |
| J1556 | BIVIGAM | intravenous immune globulin |
| J1786 | CEREZYME | imiglucerase |
| J0717 | CIMZIA | certolizumab pegol |
| J0598 | CINRYZE | C1 esterase inhibitor |
| J0584 | CRYSVITA | burosumab |
| J1555 | CUVITRU | burosumab-twza |
| J1743 | ELAPRASE | idursulfase |
| J3060 | ELELYSO | taliglucerase alfa |
| J3380 | ENTYVIO | vedolizumab |
| J1428 | EXONDYS 51 | eteplirsen |
| J0180 | FABRAZYME | agalsidase beta |
| J1572 | FLEBOGAMMA | intravenous immune globulin |
| J1566 | GAMMAGARD S/D | intravenous immune globulin |
| J1561 | GAMMAKED | intravenous immune globulin |
| J1557 | GAMMAPLEX | intravenous immune globulin |
| J1561 | GAMUNEX-C | intravenous immune globulin |
| J1559 | HIZENTRA | subcutaneous immune globulin |
| J1575 | HYQVIA SQ | subcutaneous immune globulin |
| Q5103 | INFLECTRA | infliximab-dyyb |
| J2507 | KRYSTEXXA | pegloticase |
| J0221 | LUMIZYME | alglucosidase alfa |
| J1458 | NAGLAZYME | galsulfase |
| J2182 | NUCALA | mepolizumab |
| J2350 | OCREVUS | ocrelizumab |
| J1568 | OCTAGAM | intravenous immune globulin |
| J0129 | ORENCIA | abatacept |
| J1459 | PRIVIGEN | intravenous immune globulin |
| J1745 | REMICADE | infliximab |
| Q5104 | RENFLEXIS | Infliximab-abda |
| J1602 | SIMPONI ARIA | golimumab |
| J1300 | SOLIRIS | eculizumab |
| J3357 | STELARA | ustekinumab |
| J3590 | ULTOMIRIS | ravulizumab |
| J1322 | VIMIZIM | elosulfase alfa |
| J3385 | VPRIV | velaglucerase alfa |
If you have any questions or would like to speak to a nurse care manager to discuss alternative sites of administration for your patient(s), please email Magellan Rx Management at MRxMSOS@magellanhealth.com, or call (800) 424-1762, Monday through Friday, between 8 a.m. and 5 p.m. Eastern Time.
Thank you for your cooperation and for the care you provide to our members.
