Wiki Billing for Prolia-am I understanding this correctly?

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ollielooya

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Standard dosage is 60 mgs. per one vial. HCPCS code is J0897 = injection, denosumab, 1 mg. How would the 60 mgs given to the patient with senile osteoporosis be notated in quantity? 1 vial has 60 mgs therefore wouldn't the correct designation be J0897 (60 ) with explanation on line 19? Surely, I am missing the ease of computing this!
Prolia is an expensive drug and depending on the charge per mg, would could afford this? Just stalled on billing and not sure why. Help, please and may need to followup.

Just one of those days, I guess.
 
Prolia

To bill Prolia correctly you post the J0897 and bill 60 units or mg. As the billing unit is 1mg you have to charge for 60 mg or units to receive proper reimbursement.
 
Prolia

Hi,

Can anyone answer this question: Can you code a J0897 -60 mg and a 96401 for chemo iv infusion as well?
 
You might want to utilize the search function as this topic has been addressed in the past regarding 96401 versus 96372. We use the 96401 in one of our rheumatology practices and only encountered one problem with one carrier in the past wanting us to use the 96372.
 
Prolia

We have the Prolia rep here all the time....must use J0897 w/60 units and 96401 for the Admin - payable dx 733.01. If not Medicare then must be approved prior to administering.
 
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