Subcategory Codes
As of 1/1/2013, PDEs for Barbiturates when used for epilepsy, cancer, or chronic mental health with DOS on or after January 1, 2013 will be accepted. If a PDE is submitted for a DOS prior to 1/1/2013 for a covered barbiturate, the PDE will receive Edit 738 which states "The NDC identifies a Part D Non-coverable Drug." The Exclusion Reason Code on the PDE Return File will be '223' for 'Barbiturate 2013.' Any PDEs with DOS on or after 1/1/2013 for barbiturates not indicated for use in epilepsy, cancer, or chronic mental health will continue to receive Edit 738 with an Exclusion Reason Code on the PDE Return File of '201' for 'Barbiturate.'
The updated list can be found at the link provide below:
In the event you have questions, please contact CSSC Operations at 1-877-534-2772 or via email at csscoperations@palmettogba.com.