Effective Use of ‘J-codes’ in Pharmacy Billing

Using appropriate modifiers for Podiatry to …

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Billing Guidelines for Screening Colonoscopy

Diagnosis code: V76.51 (Special screening for malignant neoplasms, colon). Some Medicare payors instruct to only use the finding since the PT modifier indicates it was done for screening. 211.3 (Benign neoplasm, colon [based on pathology report]) Example 4 Indication: Personal history of colon polyps; Colon screening

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Specialty Pharmacy Drug List

adagen aldurazyme pa aralast pa elaprase pa elelyso pa glassia pa fabrazyme pa kuvan pa, ql lumizyme pa myozyme pa naglazyme pa natpara ‡ pa orfadin pa orkambi ‡ pa, ql procysbi prolastin pa solesta vimizim zemaira pa gastrointestinal agents cholbam ‡ pa, ql gattex pa sucraid gaucher disease cerdelga pa, ql cerezyme pa vpriv pa zavesca pa

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MEDICAL BENEFIT MANAGEMENT PROGRAM SPECIALTY …

Adagen pegademase bovine Enzyme Deficiencies J2504 5/1/2019 Krystexxa pegloticase Gout J2507 5/1/2019 Lucentis ranibizumab Ophthalmic Conditions J2778 5/1/2019 Cinqair reslizumab Asthma & Allergy J2786 5/1/2019 Nplate romiplostim Blood Cell Deficiency J2796 5/1/2019 Kanuma sebelipase alfa Enzyme Deficiencies J2840 7/21/2019

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Medication Administration Site of Care

Adagen ® (pegademase) J2504 05/2017 Adakveo (crizanlizumab-tmca) J0791 07/2020 Adcetris (brentuximab vedotin)* J9042 03/2021 Aduhelm™ (aducanumab-avwa) J3590 07/2021 Aldurazyme ® (laronidase) J1931 05/2017 Alimta (pemetrexed)* J9305 03/2021 Amondys 45™ (casimersen) C9075 03/2021

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Nanoparticle Drug Delivery Systems for Cancer Treatment

polymer–drug nanoconjugate Adagen® was clinically approved for human use. Polymeric micelles Liposomes Biodegradable/ biocompatible nanoparticles Nanoparticle drug carriers Dendrimers Nanospheres, nanocapsules, nanotubes Metal nanoparticles Artificial DNA nanostructures Carbon nanoparticles Magnetic nanoparticles Drug nanoparticle conjugates

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Current Specialty Medication List (as of 01/1/2022)

Adagen Adakveo SOC Adcirca Adecetris Adefovir Adempas Adriamycin Adrucil Aduhelm Advate Advate H Advate L Advate M Advate SH Advate UH Adynovate Afinitor Afinitor Disperz Afstyla Aldurazyme Alecensa Alferon N Alimta Aliqopa ALKERAN Alphanate Alphanine SD Alprolix Alunbrig Amondys 45 Ampyra Andexxa Anjeso Apokyn ...

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Services that require precertification

Genetic and genomic tests requiring precertification The following list is a guide to the types of genetic and genomic tests that require precertification.