Medicaid In Office Injectable (Biopharmacy) Authorization Process Updates

Date: 02/22/22

Effective 03/21/2022

Dear Arizona Complete Health-Complete Care Plan (AzCH-CCCP) Providers and Staff:

Effective March 21, 2022, AzCH-CCP will implement a change to our biopharmacy authorization process. As a reminder, biopharmacy refers to drugs that are infused/given by a medical professional. If a drug (biopharmacy) is approved, the authorization will be linked to a Place of Service, meaning if the place of service that was approved is different, it must match the place of service billed on the claim. A mismatch will result in a denied claim. As a reminder, please verify that the servicing provider and place of service on the biopharmacy approval letter match the claim (CMS 1500, Field 24B) when submitting the claim.

Please see the list below of Place of Service codes that are most utilized with drug codes.

Place of Service Code(s)	Place of Service Names	Place of Service Description
11	Office	Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.
12	Home	Location, other than a hospital or other facility, where the patient receives care in a private residence.
22	On Campus- Outpatient Hospital	A portion of a hospital’s main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. (Description change effective January 1, 2016)
49	Independent Clinic	A location, not part of a hospital and not described by any other Place of Service code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only. (Effective October 1, 2003)

You may contact our pharmacy team at the number below if you need to request an update to your prior authorization or request a new prior authorization via our secure web portal.

Please contact AzCH-CCP Pharmacy Department at 888-788-4408 x 6031278 if you have any questions.