soliris administration cpt code

For questions concerning the technical VI. %PDF-1.5 %���� Instead, the administration of the following drugs in their subcutaneous or intramuscular forms should be billed using CPT code 96372. * *PLEASE NOTE NEW ALPHA NUMERIC CHDP PROGRAM SERVICE CODES. This coding information may assist you as you complete the payer forms for PERJETA. – Patient has had fewer relapses while on Soliris therapy Reauthorization is for 12 months Age Must be 2 months or older for aHUS diagnosis Must be 18 years of age or older for PNH, gMG or NMOSD diagnosis Suggested Codes ICD-10-CM diagnosis codes D59.3, D59.5, G70.00, G36.0 Billing HCPCS code J1300 (injection, eculizumab, 10 mg) These tables are provided for informational purposes only. 0 03/01/17 Annual Review, approved February 14, 2017. h�bbd```b``�"W�H�o ��X|*X�,�D���H�zV+��&X� �d�V�e��&4�Eb��ȁH�z�?D���`���)�I0 Soliris is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). Policy section and coding updated with Soliris. Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding for single-use vials and wastage. SOLIRIS is only available through a program called the SOLIRIS REMS. Instead, the administration of the following drugs in their subcutaneous forms should be billed using CPT code 96372, (therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). Added Renflexis to coverage criteria and to the coding section. �# CPT Jcode - J0850, J1459, J1561, J1568, J2788 - Intravenous Immune Globulin (IVIG) Listing of a code in this policy does not imply that the service is covered and is not a guarantee of payment. endstream endobj startxref Soliris Policy: Drug Policy (Effective 10/01/2014) 1 ... APPLICABLE CODES..... 6. SOLIRIS increases your chance of getting serious and life-threatening meningococcal infections. Visit Anthem.com to learn more about how these policies are used to determine patient coverage and medical necessity. Enrollment in the Soliris REMS program and additional information are available by telephone: 1-888-SOLIRIS (1-888-765-4747) or at www.solirisrems.com. RECENT MAJOR CHANGES . Use this page to view details for the Local Coverage Article for billing and coding: eculizumab; soliris -j1300. Generic Name Trade Name … J1300. endstream endobj startxref endstream endobj 632 0 obj <. Half-life of eculizumab is 11.25-17.25 days. Dosage and Administration Approvals may be subject to dosing limits in accordance with FDA-approved labeling, accepted compendia, and/or evidence-based practice guidelines. a The mean (SD) terminal elimination half-life and clearance of ravulizumab-cwvz in patients with PNH are 49.7 (8.9) days and 0.08 (0.022) L/day, respectively. h��[mo�F�+�r@���}9l�NԮa9��F�JtLT& �n�3�]jIS�#]�8!��rwv�ٗy8�܈�$�ȄR�J�P�k�I$1P�D ��$њAMK`ܲ�.��A�†H(�8*���@���:���l�P���� �R%�hh Soliris is indicated for the treatment of patients with paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis. Admixed solutions of Soliris are stable for 24 hours at 2-8° C (36-46° F) and at room temperature. GR-68742 (11-20) Page 1 of 2 Soliris® (eculizumab) Injectable Medication Precertification Request Aetna Precertification Notification Phone: 1-866-752-7021 . Billing Code/Availability Information HCPCS Code: J1303 − Injection, ravulizumab-cwvz, 10 mg; 1 billable unit = 10 mg NDC: Ultomiris 300 mg/3 mL single-use vials for injection: 25682-0025-xx CODING The Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS), and ICD -10 codes that may be listed in this policy are for reference purposes only. 6b�m1@�q�M����. Background U.S. Food and Drug Administration (FDA)-Approved Indications. %%EOF Soliris is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). See Important Safety Information, including Boxed Warning, and full Prescribing Information. 366 0 obj <> endobj c'�{B¥��D 631 0 obj <> endobj ��#�a��~��2`h�0�Ql?J�U�.Ą _4�z(�( Meningococcal infections may quickly become life-threatening and cause death if not recognized and treated early. 383 0 obj <>/Filter/FlateDecode/ID[<2E9928000B8EBF4096C6B1771E7E9D5E>]/Index[366 66]/Info 365 0 R/Length 88/Prev 89526/Root 367 0 R/Size 432/Type/XRef/W[1 2 1]>>stream References 1. The Soliris admixture should be administered by intravenous infusion over 35 minutes via gravity feed, a syringe-type pump, or an infusion pump. 718 0 obj <>stream Soliris [package insert]. 431 0 obj <>stream PROCEDURES AND BILLING CODES To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, HCPCS Code. ULTOMIRIS Coding & Billing Guide in PNH DOWNLOAD. Coding. For the administration of a … If an adverse reaction occurs during the administration of Soliris… %PDF-1.5 %���� 3�Vb%�H(?��Z���#E'{槌+D7�f89�;�:��p�/�R��d�����)+����%J��gK�㏀�E��)CH320�� i1��" ���e&� -��4�Dc'@� a�K� Article: Ravulizumab (ALXN1210) vs. eculizumab in adult patients with PNH naïve to complement inhibitors: the 301 study ... Infusion-Related Reactions Administration of ULTOMIRIS may result in infusion-related reactions. HCPCS Code Description HCPCS . Indications and Usage (1.3) 10/2017 Dosage and Administration (2.4, 2.5) 10/2017 Dosage and Administration (2.5, 2.6, 2.7) 07/2018 Boston, MA; Alexion … Eculizumab (Soliris®) and ravulizumab-cwvz (Ultomiris TM) are recombinant humanized monoclonal antibodies that bind to complement protein C5 and inhibits its enzymatic cleavage, blocks formation of the terminal complement complex, and thus prevents red cell lysis. VI. �!Ks����BA`�p�`F x0�@CL��&Q��t++� �h�44Xb� X��� �1 Administer Soliris at the recommended dosage regimen time points, or within two days of these time points. Dosing information for Soliris® (eculizumab). Eculizumab (Soliris®) On June 27, 2019, The U.S. Food and Drug Administration approved Eculizumab (Soliris®) for the treatment of adult patients with neuromyelitis optica spectrum disorder (NMOSD) who are anti-aquaporin-4 (AQP4) antibody positive. h�b```b``Ve`e`�*`d@ A6 ���d�°>��_s�+ׇ��-n�{W�P*������a��r�E�Y���pe>�a�(pe�c���@�� /T�4�W���������D0��t� �8� 1 INDICATIONS AND USAGE 1.1 Paroxysmal Nocturnal Hemoglobinuria (PNH) Soliris is indicated for the treatment of patients with paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis. Soliris REMS program and additional information are available by telephone: 1-888-SOLIRIS (1-888-765-4747) or at www.solirisrems.com. See Important Safety Information, including Boxed Warning, and full Prescribing Information. Source: Alexion Pharmaceuticals, 2019a. ���Z��h�� ��,(��ahY�/x�S���tX���0b���q�}�/���� �(S�� .h�Y��Q&A� dВ0� �`Co�Hr�������mS��55�5�5����g�>��Y�����c��L�q SOLIRIS can lower the ability of your immune system to fight infections. per Administration HCPCS Code Maximum Allowed Brand Generic Soliris eculizumab aHUS 1200 mg J1300 120 HCPCS units (10 mg per unit) MG/NMOSD 1200 mg J1300 120 HCPCS units (10 mg per unit) PNH 900 mg J1300 90 HCPCS units (10 mg per unit) HCPCS Code Based Maximum Dosage Information Enrollment in the Soliris REMS program and additional information are available by telephone: 1-888-SOLIRIS (1-888-765-4747) or at www.solirisrems.com. J1300 has been in effect since 01/01/2008. Under the Soliris REMS , prescribers must enroll in the program (5.2). ***Note: This Medical Policy is complex and technical. Medical policies and clinical utilization management guidelines help us determine if a procedure is medically necessary. [���RU���1�_�'y[쐴p@��~X�j A��0�GX�J&"`,Cr��"�d�9�s�J+:�"1���a�����1�� ��&�u�~ 8Y�w�\;Ϸ-D�A7�X��N.� Added HCPCS code Q5102 to coding section. %%EOF Medi-Cal Code Medi-Cal Description Age Group CHDP Code CHDP Description Reimbursement 90620 Bexsero® 10 years through 18 years 11 months* M1 VFC $9 J1300 is a valid 2021 HCPCS code for Injection, eculizumab, 10 mg or just “ Eculizumab injection ” for short, used in Medical care . SOLIRIS is a medicine that affects your immune system. 09/01/17 Interim Review, approved August 15, 2017. Billing Code/Availability Information HCPCS code: J1300 – Injection, eculizumab, 10 mg; 1 billable unit = 10 mg NDC: Soliris 300 mg/30 mL single-use vials for injection: 25682-0001-xx VII. For the drugs that are administered IV the CPT codes for IV injection/infusion should be used codes 96365-96368 and 96374-96375. Description. Code Maximum Allowed Brand Generic Soliris eculizumab aHUS 300 mg vials 25682-0001-01 4 vials/120 ml MG/NMOSD 300 mg vials 25682-0001-01 4 vials/120ml PNH 300 mg vials 25682-0001-01 3 vials/90ml Ultomiris ravulizumab-cwvz - 300 mg/30 mL solution in vials 25682-0022-01 360 mL Injection, eculizumab, 10 mg. z �( � ���c�Qr/�/=�A����>�[z�nI�(�� �a�����^�[z�nIG9�ٽ0x�����r$'{a��ꀡA�ǰ�#o���ӓl��!�jޢ�.۾Xϧ�}�X����Z>f���8���t�G~���w�q��tz��~�2o,��[�vZgu��27�zj�5;��5w���4{z���R�J�ϛ�#�dz��>��ҳ��ON��n�\�3Pp�Fϲ�b��7��"[|�z.�GX8>_ܸئ��=��`ׇ�0oz^g�bv\~^� �T�?�=1�Y�"�e�TW����+�u���C���嬚���CQ���}>+����! J1300 Injection, eculizumab (Soliris®), 10 mg J1303 Injection, ravulizumab-cwvz, (Ultomiris®) 10 mg (new code effective 10/1/19) Note: CPT codes, descriptions and materials are copyrighted by the American Medical Association (AMA). Soliris® (eculizumab) treats anti-AChR antibody-positive gMG. 666 0 obj <>/Filter/FlateDecode/ID[<2110C510EF60944CB2F00F02C3A2A744>]/Index[631 88]/Info 630 0 R/Length 144/Prev 172762/Root 632 0 R/Size 719/Type/XRef/W[1 3 1]>>stream Paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis h�bbd``b`6S�� ��$X}AI@��'��ⶃX�@,C�� �$����/KH��``bd�2��q��O^0 �4 � "y��l-��G0[H2&�!� �H�_��`6�Pf�$����s C�0 h�b```��,�� ��ea���"��F������P�J��:������6��ڸZ�6p4p4t r4�+QF�H �6���$�?DX�h�T�"���sG�����Q`}b�&�@ʁ�-�30��@�e 9��#��e`�v�(cL0 4�'� Under the Soliris REMS, prescribers must enroll in the program. FAX: 1-888-267-3277 Other policies and coverage guidelines may apply. endstream endobj 367 0 obj <>/Metadata 27 0 R/Outlines 49 0 R/PageLayout/OneColumn/Pages 364 0 R/StructTreeRoot 52 0 R/Type/Catalog>> endobj 368 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 369 0 obj <>stream 0 PERJETA Sample Coding. CPT Code 90620 (2-dose schedule) and meningococcal recombinant lipoprotein vaccine, Trumenba®, CPT Code 90621 (3-dose schedule). Drugs administered other than oral method, chemotherapy drugs.

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