DebbiePottsEngland
Guru
I have been looking for a HCPCS code for Prolia. It is a new drug and I am thinking I am going to have to use J3490 (unlisted code). I would appreciate any help.
thanks
thanks
we are not using it for chemo and I was not aware that it was a chemo drug. We are using it for osteoporosis, If I remember correctly. As of now we have not started using it. they are thinking about it. I would like to know what you are using it for. and if you have literature that you can share.
I have been looking for a HCPCS code for Prolia. It is a new drug and I am thinking I am going to have to use J3490 (unlisted code). I would appreciate any help.
thanks
We are actually using the brand name Xgeva. We are using the J3590, unclassified biologic. Also, our Medicare allowed is $1744.68 per dose. Remember that one dose of denosumab is 120mg (1 vial = 120mg) and therefore you will only bill for one unit. So be sure to set up fee schedule based on that. I found a pdf file that was very helpful on the Amgen Assist website.
Another note on the coding, we found out recently that Cahaba Medicare did not like the J3590 and requested the J9999 instead.
I hope this helped.