How To Bill Epipen For Emergency Use

SUMMARY:

Pharmacy billing procedure: The total amount reimbursed of the epinephrine auto-injection will be reimbursed by the Ontario government.
Table 2: Epinephrine Products

If administering for emergency use, the epinephrine PIN will be billed as a second claim following the influenza vaccine claim on the same day of service. Please note the cost of the epinephrine auto-injection for this transaction will appear in the dispensing fee field of the claim.
Claims must be submitted using the PIN associated with the epinephrine product. Only the acquisition cost of the drug is eligible for reimbursement. Do not enter the DIN or a mark-up or a dispensing fee.

For ODB-eligible recipients
The claim submission follows the normal process for submitting claims on the HNS with the following additional information:
• Intervention code ‘PS’: Professional Care Services
• Product Identification Number (PIN): as per the epinephrine auto-injection administered (see above)
• Valid Pharmacist ID

For Non-ODB recipients
When submitting a claim for a person who does not have ODB coverage, pharmacists must submit the following information as the second claim following the vaccine administration claim:
• Patient’s Ontario health card number
• Intervention codes PS: Professional Care Services
• Product Identification Number (PIN): as per the epinephrine auto-injection administered (see above)
• Valid Pharmacist ID code must be included with the claim Restrictions on Epinephrine Auto-Injection Epinephrine auto-injection will not be reimbursed for the following situations (other examples may apply):
• Providing the epinephrine auto-injection to the patient to self-administer or take home (for example: in the event the patient may experience an adverse event after leaving the pharmacy).
• Pharmacist emergency injection of epinephrine auto-injection not due to an adverse drug reaction resulting from the administration of the publicly funded influenza vaccine.
• Pharmacist emergency injection of epinephrine auto-injection at a nurse-led pharmacy clinic.
• Pharmacists / pharmacies that are providing any injection or inhalation for the purpose of demonstration or education.
The ministry does not accept paper claims for epinephrine auto-injection claims.

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