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A few things to verify before billing Medicaid for any injection: State-level NCCI edits may differ from Medicare NCCI edits, so verify which NCCI version applies in your state Some states require prior authorization for GLP-1 agents, biologics, and extended-release injectables even when the federal Medicare standard doesn't Managed Medicaid plans operate under commercial contracts that often have different coverage rules than fee-for-service Medicaid Medicaid prior authorization requirements for injectable drugs are among the most variable in the payer landscape

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Clinical context separates them