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Transmittal 25-12 - Inpatient Reimbursement for Physician Administered Cell and Gene Therapy


Tuesday, April 29, 2025

The purpose of this transmittal is to provide billing guidance to DC Medicaid providers regarding the reimbursement process for inpatient cell and gene therapies. The Department of Health Care Finance (DHCF) Fee-for-Service (FFS) Medicaid program will cover inpatient cell and gene therapy medications for Medicaid beneficiaries. DHCF has established specific protocols when submitting claims for these high-cost innovative cell and gene therapies. Inpatient cell and gene therapy medications are not a covered service under the DC Health Care Alliance program.