How to bill for Dupixent injection?
Asked by: Willy Bailey | Last update: February 24, 2025Score: 4.7/5 (34 votes)
How to bill for Dupixent?
But there should be an information billed in HCFA (CMS-1500) Form's box-19. For Medicare, Medicaid and their Advantage & Managed care Plans, the Dupixent J Code is J3590. This code is used to bill for the drug when it is administered in a doctor's office or clinic.
What is the difference between 96401 and 96372?
The two CPT codes in question are: 96372, therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular. 96401, chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic.
What is the CPT code for biologic injection?
CPT® 96401, Under Injection and Intravenous Infusion Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration.
Why won't my insurance cover Dupixent?
Why Do Insurance Companies Deny Dupixent? A shot of Dupixent can cost as much as $3,354—or more, in some cases. Your insurance company may deny your prescription for Dupixent because it is not on the formulary list, or because they don't believe the drug is medically necessary for your condition.
DUPIXENT® (dupilumab) Supplemental Injection Training Video
How to pay for Dupixent?
The majority of DUPIXENT patients with commercial/employer-provided insurance use the DUPIXENT MyWay ® Copay Card. Eligible US residents with an FDA-approved prescription for DUPIXENT may pay as little as $0 copay per fill of DUPIXENT (annual maximum of $13,000).
How do I get prior authorization for Dupixent?
You can obtain the appropriate PA form through DUPIXENT MyWay®, CoverMyMeds®, or your patient's insurance provider or specialty pharmacy. Consider including a letter that explains your patient's condition in detail.
What is the CPT billing code for injection?
Subcutaneous and Intramuscular Injection Non-Chemotherapy
Instead, the administration of the following drugs in their subcutaneous or intramuscular forms should be billed using CPT® code 96372, (therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular).
What is the J code for dupixent?
HCPCS J3490 (unclassified drugs) or J3590 (unclassified biologics) are HCPCS codes you can use for Dupixent.
Does Medicare pay for biologic injections?
Many Part B covered drugs are infused or injected by physicians such as oncologists, rheumatologists, and urologists. Generally, Part B covers only drugs that are not usually self-administered. Medicare Part B pays for covered drugs and biologicals, including covered preventive vaccines, using several methodologies.
When do you bill 96401?
CPT 96401 is for the administration of antineoplastic chemotherapeutic agents and biologic response modifiers. Traditional antineoplastic chemotherapy agents and the newer biologic response modifiers have a higher patient risk, requiring special knowledge for use and requires longer patient monitoring.
How do I bill 96372 for 2 injections?
If a provider wishes to report multiple injections (intramuscular or subcutaneous) of the same therapeutic medication, he or she may choose to report code 96372 (therapeutic, prophylactic, or diagnostic injection [specify substance or drug]). The number of administrations would be reported as the units of service.
Why is Medicare denying 96372?
Inappropriate or missing modifier. CPT code 96372 is not properly documented, indicating that a procedure or service was distinct or independent from other services performed on the same day. CPT code 96372 is used for certain types of vaccinations. Most vaccinations are typically coded with 90471 or 90472.
What diagnosis is DUPIXENT injection?
How do you prescribe DUPIXENT?
The recommended dosage of DUPIXENT for adult patients is an initial dose of 600 mg (two 300 mg injections), followed by 300 mg given every other week (Q2W). The recommended dosage of DUPIXENT for pediatric patients 6 months to 5 years of age is specified in Table 1.
Does Medicare pay for Dupixent?
Do Medicare prescription drug plans cover Dupixent? Yes. 99% of Medicare prescription drug plans cover this drug.
What is the J code for biologic injection?
NOC codes are for “Unclassified drugs” or “Not Otherwise Classified” drugs (J3490) and biologics (J3590).
What class of drug is Dupixent?
Dupilumab injection is in a class of medications called monoclonal antibodies. It works by stopping the action of certain substances in the body that cause inflammation.
How to bill J code correctly by unit?
When submitting a claim for a J-coded medication, you'll include the J-code itself alongside the number of units used. This allows insurance companies to understand the exact medication and dosage billed.
Does 20610 need a modifier?
The appropriate site modifier (RT or LT) must be appended to CPT code 20610 or CPT code 20611 to indicate if the service was performed unilaterally and modifier (-50) must be appended to indicate if the service was performed bilaterally.
How many units to bill for J1071?
Use J1071 X how many units the pt. was given. For example if the pt. received 200 mg, bill J1071 X200.
What is the approved diagnosis for DUPIXENT?
- Uncontrolled moderate-to-severe eczema.
- Uncontrolled moderate-to-severe eosinophilic. or oral steroid dependent asthma.
- Inadequately controlled chronic obstructive pulmonary. ...
- Uncontrolled chronic rhinosinusitis. ...
- Eosinophilic esophagitis (EoE)
- Prurigo nodularis (PN)
How do you qualify for DUPIXENT?
Dupixent is indicated for the treatment of patients aged 12 years and older with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable.
How much is DUPIXENT without insurance?
The cost for Dupixent (200 mg/1.14 mL) subcutaneous solution is around $4,178 for a supply of 2.28 milliliters, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans.