There is an update to how the NYS Medicaid Pharmacy program will reimburse the pharmacies for vaccines that are billed by the NDC#.

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This change does not apply to the vaccines administered under Vaccines for children program.

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Proper Billing: for any vaccines that are billed by the NDC

One claim should be submitted with a pharmacy usual and customary price  of the vaccine billed by the NDC, in the National Council for Prescription Drug Programs (NCPDP) field 426-DQ.

No separate claim for the administration of the vaccine should be submitted.

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Reimbursement:

The total amount reimbursed in the field NCPDP field 509-F9, will include the administration fee and the reimbursement of the vaccine, when billed by NDC.

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Have further questions, please contact :

1.Pharmacy policy questions should be directed to NYRx at NYRx@health.ny.gov.
2.Billing questions should be directed to eMedNY at (800) 343-9000

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