New Drug and Biologic Edits

New drug edits will soon be implemented in our second pass claims editor later in March 2024 and throughout the remainder of the year.

These upcoming edits will address such topics as the frequency of drugs billed for Pompe disease, correct diagnosis coding for select immune globulin drugs, and the billing of specialized monoclonal antibody products by provider specialties other than home infusion therapy.

Later in 2024, additional drug edits supporting medical policies will be implemented. These edits will address a subset of drugs that can be administered in the physician office. They will cover such items as dosage, dose frequency limits per FDA prescribing information, age restrictions on the drugs, and treatment contraindications.

Watch Provider News for additional information on these upcoming edits.