MedicaidPrior AuthMedium impact
Medicaid Payment of Synagis
Maryland Medicaid·MD · Pediatrics, Pulmonology·Pharmacy
Effective date
Mar 15, 1999
We identified it
Jun 20, 2026
Summary
Maryland Medicaid establishes special billing procedures for Synagis (palivizumab) injections due to high cost. Physicians must use CPT 99199 for administration and office visits, while pharmacies require preauthorization through MCFCA before dispensing.
Action Required
For Maryland Medicaid patients receiving Synagis: Billing team must use CPT 99199 for administration and office visits, adding 'Synagis, office exam level:' plus exam complexity in block 24D. Providers must fax completed authorization form to MCFCA (410-333-7049) before administration. Pharmacies must call 410-767-1693 for preauthorization after initial rejection. Coordinate medication pickup/delivery from pharmacy to ensure proper refrigeration.