SelectHealth from VNS Health Coverage of Drugs Provided as Part of a Medical Visit/Incidental to Medical Visit

For drugs provided as part of a medical visit or incidental to a medical visit, Providers may bill covered drugs via the applicable J-Code and will be reimbursed based on the applicable drug fee schedule. (Access our Provider Manual for general billing guidelines)

To obtain the drugs, Providers may choose to:

1. buy-and-bill – providers are responsible for ordering and purchasing the drug through source of choice and billing SelectHealth from VNS Health for reimbursement
2. obtain directly from a Specialty Pharmacy within our medical network via:

white bagging (provider obtains an infusion or specialty drug directly from a specialty pharmacy)

brown bagging (drugs designated for self-administration or practitioner administration are dispensed or shipped directly to a member by the pharmacy. This is only acceptable when the drug is intended, prescribed, or labeled for self-administration). 

For any questions about SelectHealth from VNS Health medical coverage related to Physician Administered Drugs (PAD), please call 1-866-783-0222, Monday–Friday, 8 am–5 pm. For claims and payment information and resources, please visit: https://www.vnshealthplans.org/health-professionals/claims-billing-and-payments/

To find a pharmacy in our medical network, please click the following link: https://www.vnshealthplans.org/health-professionals/search-for-in-network-providers/ and choose “SelectHealth Provider & Pharmacy Search”. Listed below are a few specialty pharmacies within our medical network:

1. OptionCare Trinity – (800) 961-9979
2. Mannings Pharmacy – (212) 941-6480