Section 90, Physician Drug Rate Updates, CRs 127124 & 127125

Oct 10, 2024

Quarter 3 Updates

The Department has retroactively updated the Physician Drug Rates effective July 1, 2024, in alignment with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate update. These new rates were implemented for billing on September 25, 2024. 

The updated rates can be found on the Rate Setting page of the Health PAS Online Portal.  

Adjustment of Claims 

• The Department will adjust claims that were submitted at or above the new rates, for dates of service July 1, 2024, through September 25, 2024. No provider action is required.   

Retroactive Updates Effective 2023 & 2024

The Department has retroactively updated the rates for multiple codes in alignment with a rate update from CMS.   

See the table below for a list of affected codes with the new rates and effective dates that were implemented for billing on October 9, 2024. 

 

Code	Current Rate	Correct Rate	Start Date	End Date
A9575	$0.13	$0.12	1/1/2024
J0461	$0.07	$0.09	4/1/2024
J1817	$7.56	$7.60	4/1/2024
J9120	$594.55	$720.16	7/1/2023	9/30/2023
J9179	$137.67	$137.79	4/1/2024
J9330	$33.64	$33.57	7/1/2023	9/30/2023
J9358	$26.24	$26.32	7/1/2023	9/30/2023
J9358	$26.38	$26.31	10/1/2023	12/31/2023
J9358	$27.24	$27.31	1/1/2024	3/31/2024
Q4133	$145.42	$139.38	7/1/2023	9/30/2023
Q5103	$18.43	$17.58	7/1/2023	9/30/2023
Q5106	$7.50	$7.22	7/1/2023	9/30/2023
Q5116	$23.15	$21.93	7/1/2023	9/30/2023
Q5119	$27.51	$24.72	7/1/2023	9/30/2023

 

The Department will reprocess affected claims that were submitted at or above the new rates. No provider action is required.    

For questions, please contact your Provider Relations Specialist.