Temporary Coverage for Extencilline
The South Carolina Department of Health and Human Services (SCDHHS) will cover, for a limited time, imported benzathine benzylpenicillin (Extencilline) for use in outpatient medical drug claims when billed with HCPCS code J0561 and at an outpatient pharmacy (point-of-sale). This policy change to provide temporary coverage is to address the ongoing shortage of Bicillin® L-A (penicillin G benzathine injectable suspension). The FDA has provided Extencilline distribution and administration information in a letter to health care providers. SCDHHS' coverage of imported Extencilline is limited to dates of service on or after Jan. 16, 2024, and will end when the shortage has resolved. The end date for this time-limited coverage will be announced via a future Medicaid bulletin.
The preparation and administration of Extencilline and the contraindications for prescribing differ from those for Bicillin® L-A. Benzathine benzylpenicillin is another name for penicillin G benzathine. Extencilline will only be available by prescription in the United States.
Extencilline will be covered for full-benefit Healthy Connections Medicaid members and those enrolled in the family planning limited-benefit program when billed with HCPCS code J0561 - Injection, penicillin G benzathine, 100,000 units. The following lots and batches are approved for use.
| Product Description | Strength | Packaging | National Drug Code (NDC) Number |
|---|---|---|---|
| Extencilline (benzathine benzylpenicillin) Powder and diluent for reconstitution for injection, 1,200,000 units | 1,200,000 units | 20 ml vials of powder for suspension 5 ml of water for injection in ampules | 81284-0521-01 |
| Extencilline (benzathine benzylpenicillin) Powder and diluent for reconstitution for injection, 2,400,000 units | 2,400,000 units | 20 ml vials of powder for suspension 5 ml of water for injection in ampules | 81284-0522-01 |
Billing instructions based on the claim type are below.
For medical claims:
- Providers must bill the product with HCPCS code J0561 - Injection, penicillin G benzathine, 100,000 units.
- For Medicaid billing purposes, one Medicaid unit equals 100,000 units of the drug.
- Providers must bill the 11-digit NDC number and appropriate NDC units.
For pharmacy claims:
- Providers must bill the 11-digit NDC number and appropriate NDC units.
South Carolina's Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in this bulletin for Healthy Connections Medicaid members who are enrolled in an MCO.
Providers should direct any questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers can also submit an online inquiry to the PSC at https://www.scdhhs.gov/providers/contact-provider-representative.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.