Wiki Billing Prolia

[mcubed1205]

Has anyone billed for Prolia administered in the office? I was told to use J3490 for the medication and 96372 for the administration. Are these correct and if so, are you getting reimbursed and at what rate?

Thanks.

 

[jmcdaniel]

Prolia

Hey. I have a Prolia rep here now. The reimbursement is $872 for Medicare. It is higher for commerical insurance. The admin fee is around $20. Those are the correct codes to use. You can also bill an office visit with a 25 modifier if needed. If you have any questions, you can email me at jmcdanielcpc@gmail.com and I will be happy to help you.

 

[stephanie7480]

J3490 is a "drug" J3590 is a biologic - Prolia ia a biologic. My research has found that J3590 is the correct code.
This is an article for NGS (MAC) http://apps.ngsmedicare.com/sia/article_a50361.htm

I have not been able to locate documentation for CGS for the correct code. Only their allowable. http://apps.ngsmedicare.com/sia/article_a50361.htm

If anyone can assist with documentation I would appriciate it!

Stephanie W, CPC

 

[gina_marie]

Our Prolia rep said to use J3490. You have to be sure to put "Prolia (denosumab) 60 mg, SC injection, NDC#55513071001" in box 19. The $892 is correct, we only do this on Medicare patients but you would increase that rate for non-Medicare patients. We still have not gotten reimbursed for ours and our Prolia rep said the first time you file for a patient can take a long time. If you would like to email me at gsavarino@e-mds.com I can send you my billing and coding guide that was sent to me from our rep. 96372 is the correct admin code.

Gina