Mirena – Rate Increase
Some providers have recently indicated that as a result of a recent price increase by the manufacturer, the Medicaid allowable for Mirena, J7302, was below the acquisition cost. The Medicaid Program current updates the rates for J codes on a quarterly basis. The first quarter update appears to have resolved this problem. The allowable for J7302 was increased to $738.20, effective April 1, 2010. The rate adjustment appears to have been downloaded to the online fee schedule yesterday. The May 2, 2010 rate adjustment mentioned above maintains the $738.20 allowable.
Physician administered drugs are included on the Medicaid physician fee schedule. As such, providers may look up the Medicaid allowable for a specific code using the on-line Medicaid fee schedule. Visit www.indianamedicaid.com select the Provider portal then select Fee Schedule on the right side of the screen.
