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New Billing Instructions for Hemlibra- Emicizumab Injection pdf

Connecticut Medicaid (HUSKY Health)·CT · Hematology·Provider Bulletin
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply

Summary

Connecticut Medicaid providers billing Hemlibra (emicizumab) injections must now submit claims with units billed in milliliters (ML) instead of 'Each' units. This change affects specific NDC codes and requires recalculating dispensed quantities based on concentration and total mg dispensed.

Action Required

Action needed
Immediately: Pharmacy billing staff must update billing system to submit Hemlibra claims using NDC codes 50242-0920-01, 50242-0921-01, 50242-0922-01, or 50242-0923-01 with units in milliliters (ML) in Field 12 (Quantity Dispensed). Calculate dispensed quantity by dividing total mg dispensed by concentration (e.g., 120mg ÷ 30mg/ml = 4 units). This applies only to Hemlibra - continue billing other anti-hemophilic factors as 'Each'.