How do I file a claim with Medicaid if a teaching dose of ENBREL has been administered in my office?
If a teaching dose or teaching doses of ENBREL are administered in your office, the CPT code 90782 (therapeutic subcutaneous injection) may apply. A state Medicaid administrator may advise you to use the ENBREL-specific HCPCS code J1438 (“etanercept-ENBREL”) to file the claim. Some Medicaid programs may also require a local code. Please contact the Reimbursement Support Services at 1-888-4ENBREL (1-888-436-2735) to determine which code the state administrator has advised should be used.
