Tepezza Cpt Code


Durable Medical Equipment. Code Description HCPCS. 6 The following codes may be used to report the administration of TRAZIMERA: Type of Code Code/Descriptor 6 Relevant Sites of Service Hospital outpatient departments use revenue codes to report specific accommodations and/or ancillary charges. Compliance with glycemic control should be encouraged. We would like to show you a description here but the site won't allow us. ING-CC-0163. General Coding and Billing. CPT code 99211—which is the E&M code for an established patient, level 1—is bundled with each of the new codes, but both of those CCI edits can be unbundled if both services are medi­cally necessary. Applicable Procedure Codes C9061 Injection, teprotumumab-trbw, 10 mg. Teprotumumab (Tepezza™) is a fully human antibody that targets the insulin-like growth factor-1 receptor (IGF-1R) indicated for the treatment of active thyroid eye disease (TED) / Graves' disease in adult individuals 18 years of age and older. References 1. Packwood, MD, Chair of AAPOS Socioeconomic Committee. Search: Tepezza Cpt Code. Fee Schedule Update Policy. Early Intensive Behavorial Intervention Services. CPT / HCPC Code Drug (Brand Name) Covered Indications / Other Supported Uses Recommended Dosing (where available) • Third dose: 100 mg/kg IV infused over 16 hours; max dose: 10 g/dose. Gateway Health Policy Disclaimer. C9077, J3490 ™ Removed Monoferric (ferric derisonmaltose), Tepezza. Packwood, MD, Chair of AAPOS Socioeconomic Committee. Reported infusion reactions have usually been mild or moderate in severity. The purpose of the Horizon Medical Policy Manual is to provide clinical policies applicable to the administration of health benefits insured or administered by Horizon Blue Cross Blue Shield of New Jersey, Horizon Healthcare of New Jersey, Inc. Service Category CPT/HCPCS Codes Ancillary Services Medicare. Register for upcoming CME webinars. Add on code G0332 1st hour inf 90765 Addl hr(s) inf 90766 IV Push (usually not done) 90775 Drug(s) list separately HCPCS Code(s) MISC Prolonged services-up to 1hr 99358 With some insurance carriers, you will need to add modifier -59 to the pushes and/or infusion supplies code. About These Policies Medical Policies. The product's dosage form is injection, powder, lyophilized, for solution, and is administered via intravenous form. Note: 1) This list of codes may not be all-inclusive. Preexisting Inflammatory Bowel Disease: TEPEZZA may cause an exacerbation of preexisting inflammatory bowel disease (IBD). The initial dose is 10 mg/kg. 5 hours after an infusion. Definition. Tepezza * Non-oncology use is managed by the medical specialty drug review team. The billing party is solely responsible for coding of services (eg, CPT coding). Effective with date of service Jan. If your test, item or service isn't listed, talk to your doctor or other health care provider. Effective with date of service Jan. By accessing this Medical Policy Manual, you acknowledge receipt and agreement with the information below. These codes are primarily billed for Commercial insurances. Tepezza ® (Teprotumumab-Trbw Listing of a code in this policy does not imply that the service descrbi ed by the code is a covered or non -covered health service. Add on code G0332 1st hour inf 90765 Addl hr(s) inf 90766 IV Push (usually not done) 90775 Drug(s) list separately HCPCS Code(s) MISC Prolonged services-up to 1hr 99358 With some insurance carriers, you will need to add modifier -59 to the pushes and/or infusion supplies code. Please see Full Prescribing Information for more information. Evaluation and Management Services. Monitor patients with IBD for flare of disease. , Horizon Insurance Company, and Healthier. Infusion reactions have been reported in approximately 4% of patients treated with Tepezza. (A list of codes can be found on page 3, section 12) Alcohol Dependence Opioid Dependence ICD-10 ICD-10 F10. 251 Intermittent exophthalmos. Service Category CPT/HCPCS Codes Ancillary Services Medicare. Douglas RS, Kahaly GJ, Patel A, et al. References. The NDC must follow the 5digit4digit2digit format (11-digit billing format, with no spaces, hyphens or special characters). These guidelines provide claims payment editing logic for CPT, HCPCS and ICD-10-CM coding. This is the first FDA-approved drug treatment for thyroid eye disease. • C9061 Injection, teprotumumab-trbw, 10 mg (deleted 09-30-2020) • J3241 Injection, teprotumumab-trbw, 10 mg (effective 10-01-2020) REFERENCES • Tepezza [package insert]. Tepezza® (teprotumumab) is contraindicated during pregnancy : CODING : Note: The Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS), and the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD -10) codes that: may: CPT Code Description :. The cost for Tepezza intravenous powder for injection trbw 500 mg is around $15,565 for a supply of 1 powder for injection, depending on the pharmacy you visit. KEYTRUDA is a medicine that may treat certain cancers by working with your immune system. CPT / HCPC Code Drug (Brand Name) Covered Indications / Other Supported Uses Recommended Dosing (where available) • Third dose: 100 mg/kg IV infused over 16 hours; max dose: 10 g/dose. If the NDC on the package label is less than 11 digits, a leading zero must. CPT code 99211—which is the E&M code for an established patient, level 1—is bundled with each of the new codes, but both of those CCI edits can be unbundled if both services are medi­cally necessary. Member has not received ≥ 8 Tepezza infusions (including the initial 10 mg/kg first infusion); 10. These codes are primarily billed for Commercial insurances. KEYTRUDA is a medicine that may treat certain cancers by working with your immune system. J0120 Injection, tetracycline, up to 250 mg J0121 Injection, omadacycline, 1 mg J0122 Injection, eravacycline, 1 mg J0129 Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered). Gateway Health's Policies should not be construed as providing medical advice or treatment or guaranteeing the outcome or results of any medical services/treatments and/or procedures Providers are responsible for providing medical advice and treatment, are independent contractors, and are. Note 1: Payment allowance limits subject to the ASP methodology are based on 3Q 2021 ASP data. Tepezza may cause infusion reactions. Tepezza [package insert]. Dermatology. Search: Tepezza Cpt Code. They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. The Centers for Medicare & Medicaid Services (CMS) released on May 13 the July 2020 quarterly update to the HCPCS Level II file. Member has not received ≥ 8 Tepezza infusions (including the initial 10 mg/kg first infusion); 10. Dublin, Ireland; Horizon Therapeutics Ireland, DAC, January 2020. TEPEZZA® (teprotumumab-trbw) is the first and only FDA-approved treatment for this autoimmune condition. Tepezza™ (teprotumumab-trbw) by Horizon Therapeutics was approved by the FDA on January 21, 2020. Non-Emergent Air Ambulance ; A0430, A0431, A0435, A0436 (Tepezza®) J3241. Cpt Tepezza Code. Step therapy updates. You should discuss the risks and benefits of using TEPEZZA with your doctor. HCPCS code J0897 is defined as 1 mg. Tepezza™ NDC #: 75987-0130-15 ASD Healthcare gathers code information from the Centers for Medicare and Medicaid Services (CMS. Medical policies are used by all plans and lines of business unless Federal or State law—as well as contract language, including definitions and specific contract provisions. Register for upcoming CME webinars. 5 hours after an infusion. The FDA granted this drug priority review, fast track, breakthrough therapy, and orphan drug designation. Note: CPT codes, descriptions and materials are copyrighted by the American Medical Association (AMA). Diagnosis Code Description E05. About Tepezza Cpt Code. The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. ING-CC-0163. They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. Accessed February 2021. Brand name Generic name J code National Drug Codes (NDCs) Date of FDA approval Aduhelm aducanumab-avwa J3590 64406-101-01, 64406-102-02 June 7, 2021 Camcevi leuprolide mesylate J9999 NA May 25, 2021 Nexviazyme avalglucosidase alfa-ngpt J3590 58468-0426-1 August 6, 2021 Ryplazim plasminogen human-tvmh J3590 70573-099-01 June 4, 2021. If the NDC on the package label is less than 11 digits, a leading zero must. Definition. PROCEDURES AND BILLING CODES To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD diagnostic codes. 1, 2020, CMS has added new HCPCS codes (J codes), deleted others and changed the description of some existing codes. it: Cpt Tepezza Code. CPT code 99211—which is the E&M code for an established patient, level 1—is bundled with each of the new codes, but both of those CCI edits can be unbundled if both services are medi­cally necessary. 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of the day or night. C9077, J3490 ™ Removed Monoferric (ferric derisonmaltose), Tepezza. For all other services, please reference the inpatient and outpatient requests to complete your request online or call 1-800-523-0023. HCPCS code J0897 is defined as 1 mg. Infusion reactions may occur during an infusion or within 1. Tepezza (teprotumumab-trbw) is an insulin-like growth factor-1 receptor inhibitor indicated for the treatment of Thyroid Eye Disease. Laboratory Services. Gateway Health's Policies should not be construed as providing medical advice or treatment or guaranteeing the outcome or results of any medical services/treatments and/or procedures Providers are responsible for providing medical advice and treatment, are independent contractors, and are. TE Code RLD RS; TEPEZZA: TEPROTUMUMAB-TRBW: 500MG: INJECTABLE;INJECTION: Prescription: None TBD: No: Approval Date(s) and History, Letters, Labels, Reviews for BLA 761143. About Tepezza Cpt Code. CPT ® * Code. Effective for dates of service on and after January 1, 2022,. Current Procedural Terminology (CPT®) codes define specific medical procedures performed by physicians. All codes should be verified between the. Brand name Generic name J code National Drug Codes (NDCs) Date of FDA approval Aduhelm aducanumab-avwa J3590 64406-101-01, 64406-102-02 June 7, 2021 Camcevi leuprolide mesylate J9999 NA May 25, 2021 Nexviazyme avalglucosidase alfa-ngpt J3590 58468-0426-1 August 6, 2021 Ryplazim plasminogen human-tvmh J3590 70573-099-01 June 4, 2021. Clinical Criteria. Tildrakizumab. 036: 01/01/2014: Non-Invasive Home Ventilators (PDF) CP. Teprotumumab for the treatment of active thyroid eye disease. Dublin, Ireland; Horizon Therapeutics Ireland, DAC, January 2020. Musculoskeletal policies including hip, knee, shoulder and spine related services. About Code Cpt Tepezza. Durable Medical Equipment. • C9061 Injection, teprotumumab-trbw, 10 mg (deleted 09-30-2020) • J3241 Injection, teprotumumab-trbw, 10 mg (effective 10-01-2020) REFERENCES • Tepezza [package insert]. Max Units (per dose and over time) [HCPCS Unit]: 115 billable units initially followed by 230 billable units every 3 weeks thereafter for a total of 8 doses ; Initial Approval Criteria 1-8,10. This list only includes tests, items and services that are covered no matter where you live. Step therapy updates. Tepezza (replaced code C9061) 01/29/21 Addition Incontinence Supplies diapers, wipes, underpads 12/22/20 Addition Genetic testing (S3800,S3840,S3841,S3842,S3846) 03/01/21 Addition. Medical Policy. *If not well tolerated, the minimum infusion duration should remain at 90 minutes. The purpose of the Horizon Medical Policy Manual is to provide clinical policies applicable to the administration of health benefits insured or administered by Horizon Blue Cross Blue Shield of New Jersey, Horizon Healthcare of New Jersey, Inc. Tepezza (replaced code C9061) 01/29/21 Addition Incontinence Supplies diapers, wipes, underpads 12/22/20 Addition Genetic testing (S3800,S3840,S3841,S3842,S3846) 03/01/21 Addition. To see a list of all medical policies and clinical UM guidelines, visit our Full List page. Medical policies are used by all plans and lines of business unless Federal or State law—as well as contract language, including definitions and specific contract provisions. Tildrakizumab. Share your location or enter your city or zip code to find studies near you. Early Intensive Behavorial Intervention Services. 031: 01/01/2013: Never Paid Events (PDF) CC. If IBD exacerbation is suspected, consider discontinuation of TEPEZZA. Cpt Tepezza Code. TEPEZZA® (teprotumumab-trbw) is the first and only FDA-approved treatment for this autoimmune condition. HCPCS or CPT Code(s) Drug *ING-CC-0062. Register for upcoming CME webinars. Definition. For all other services, please reference the inpatient and outpatient requests to complete your request online or call 1-800-523-0023. Home Infusions Description HCPCS Code Medicare Will not pay *. Dublin, Ireland; Horizon Therapeutics Ireland, DAC, January 2020. Hyperglycemia: Increased blood glucose or hyperglycemia may occur in patients treated with TEPEZZA. Signs and symptoms may include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache, and muscular pain. About Code Cpt Tepezza. These Medical Policies describe when medical services are considered medically necessary, not medically necessary or investigational. All codes should be verified between the. HCPCS code J311 is defined as 1 mg. If the NDC on the package label is less than 11 digits, a leading zero must. Advanced Search. References 1. Action Date Submission Action Type Submission Classification. Other Other Patient has tried and failed the following medication(s):. HCPCS codes primarily correspond to services, procedures, and equipment not covered by CPT ® codes. SCDHHS has the responsibility to maintain the manual to be used by county governments and their designees to administer MIAP. CPT / HCPC Code Drug (Brand Name) Covered Indications / Other Supported Uses Recommended Dosing (where available) • Third dose: 100 mg/kg IV infused over 16 hours; max dose: 10 g/dose. Billing Code/Availability Information HCPCS code: J3241 – Injection, teprotumumab-trbw, 10 mg: 1 billable unit = 10 mg NDC: Tepezza 500 mg single-dose vial for injection: 75987-0130-xx VII. These codes are primarily billed for Commercial insurances. Teprotumumab-Trbw for Injection, for Intravenous Use (Tepezza™) HCPCS Code J3590: Billing Guidelines. Lake Forest, IL: Horizon Therapeutics USA, Inc. These Medical Policies describe when medical services are considered medically necessary, not medically necessary or investigational. It also improves the signs and symptoms of Thyroid Eye Disease (TED), including eye pain, redness, and swelling. PROCEDURES AND BILLING CODES To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD diagnostic codes. If your test, item or service isn't listed, talk to your doctor or other health care provider. PATIENT DIAGNOSIS—Please complete the diagnosis code(s) you would like to use by filling in the additional digits. In addition to the active and pending Medical Policies, BCBSIL has included policies which. Erythropoietic protoporphyria Please refer to the ICD-10-CM Manual for a complete description of the diagnosis code. Dermatology. Register for upcoming CME webinars. Hyperglycemia: Increased blood glucose or hyperglycemia may occur in patients treated with TEPEZZA. General Coding and Billing. 2020;382 (4):341-352. Max Units (per dose and over time) [HCPCS Unit]: 115 billable units initially followed by 230 billable units every 3 weeks thereafter for a total of 8 doses ; Initial Approval Criteria 1-8,10. Member has not received ≥ 8 Tepezza infusions (including the initial 10 mg/kg first infusion); 5. This section contains Medical Policies approved by Blue Cross and Blue Shield of Kansas City ("BCBSKC"). CPT Code 92060 for the Sensorimotor Exam: Answers to Your FAQs By Sue Vicchrilli, COT, OCS, OCSR, Academy Director of Coding and Reimbursement; Traci Fritz, COE, Vice Chair of AAPOS Socioeconomic Committee; and Eric A. TEPEZZA solution in the vial and the diluted solution in the infusion bag containing 0. 28, 2020, the Medicaid and NC Health Choice programs cover teprotumumab-trbw for injection, for intravenous use (Tepezza™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics. Medical policy determines if, and under what circumstances, medical services may be eligible for coverage. Tepezza (replaced code C9061) 01/29/21 Addition Incontinence Supplies diapers, wipes, underpads 12/22/20 Addition Genetic testing (S3800,S3840,S3841,S3842,S3846) 03/01/21 Addition. Home Infusions Description HCPCS Code Medicare Will not pay *. Additional information about our medical policies. TEPEZZA® (teprotumumab-trbw) is the first and only FDA-approved treatment for this autoimmune condition. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of the policy bulletins is permitted for. You can also view the retired medical policies and out-of-area medical policies. Laboratory Services. CR 11963 Key points. N Engl J Med. Crysvita *ING-CC-0162. Providers should report 1 unit for each 1 mg dose provided during the billing period. National Drug Code 75987-130 is assigned to tepezza with active ingredient(s) teprotumumab and is labeled by Horizon Therapeutics USA, Inc. Service Category CPT/HCPCS Codes Ancillary Services Medicare. 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of the day or night. ING-CC-0163. Find enrollment forms, payer access information, and more in this comprehensive resource library. The NDC must follow the 5digit4digit2digit format (11-digit billing format, with no spaces, hyphens or special characters). Home Infusions Description HCPCS Code Medicare Will not pay *. This section contains Medical Policies approved by Blue Cross and Blue Shield of Kansas City ("BCBSKC"). Original Approvals or Tentative Approvals. Crysvita *ING-CC-0162. Medical policies for Medicare Advantage members: We are required to make coverage determinations for services. Definition. If IBD exacerbation is suspected, consider discontinuation of TEPEZZA. Unlisted procedure, skin, mucous membrane and subcutaneous tissue. For precertification, call (866) 752-7021 (Commercial), (866) 503-0857 (Medicare), or fax (866) 267-3277. 1, 2020, CMS has added new HCPCS codes (J codes), deleted others and changed the description of some existing codes. ; January 2020. Current Procedural Terminology (CPT) and Level II HCPCS codes. Definition. Register for upcoming CME webinars. 2021: Author: baragure. 9% Sodium Chloride Injection, USP is a total of 4 hours at room temperature 20°C to 25°C (68°F to 77°F) or up to. The billing party is solely responsible for coding of services (eg, CPT coding). Because government and other third-party payer coding requirements change periodically, please verify current coding requirements directly with the payer being billed. HCPCS codes, descriptions and materials are copyrighted by Centers for Medicare Services (CMS). 6 The following codes may be used to report the administration of TRAZIMERA: Type of Code Code/Descriptor 6 Relevant Sites of Service Hospital outpatient departments use revenue codes to report specific accommodations and/or ancillary charges. ING-CC-0163. About These Policies Medical Policies. Find coding info, payer access materials, and more. Tepezza Prices. Quantity limit updates. PROCEDURES AND BILLING CODES To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD diagnostic codes. Inclusion of a code in this section does not guarantee that it will be reimbursed,. Effective for dates of service on and after January 1, 2022,. Gateway Health Policy Disclaimer. Crysvita *ING-CC-0162. Thyroid eye disease is a rare, autoimmune disease, in which the muscles and fatty tissues behind the eye become inflamed, causing the eyes to be. Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm. The administration of these three drugs do not meet the criteria specified in this section, instead, an appropriate code from the 96365-96376 section should be selected to represent. PROCEDURES AND BILLING CODES To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD diagnostic codes. HCPCS Code Description J3241. Teprotumumab for the Treatment of Active Thyroid Eye. Benefit Application. If you are looking for Tepezza Cpt Code, simply check out our info below :. Adult / Pediatric • Herpes simplex encephalitis • Herpes simplex virus (HSV), genital infection (severe). Member has not received ≥ 8 Tepezza infusions (including the initial 10 mg/kg first infusion); 5. Non-Emergent Air Ambulance ; A0430, A0431, A0435, A0436 (Tepezza®) J3241. Code Description HCPCS. TEPEZZA is given once every 3 weeks for a total of 8 IV infusions 1. For precertification, call (866) 752-7021 (Commercial), (866) 503-0857 (Medicare), or fax (866) 267-3277. It also improves the signs and symptoms of Thyroid Eye Disease (TED), including eye pain, redness, and swelling. Providers should be knowledgeable about BCBSIL Medical Policies. , Horizon Insurance Company, and Healthier. 9% Sodium Chloride Injection, USP is a total of 4 hours at room temperature 20°C to 25°C (68°F to 77°F) or up to. Cpt Tepezza Code. In addition to the active and pending Medical Policies, BCBSIL has included policies which. Quantity limit updates. Reported infusion reactions have usually been mild or moderate in severity. 251 Intermittent exophthalmos. Note: Drugs with their own HCPC code may not be billed using a. Tepezza * Non-oncology use is managed by the medical specialty drug review team. Crysvita *ING-CC-0162. Code Description HCPCS. They can help you understand why you need certain tests, items or services. Current Procedural Terminology (CPT) and Level II HCPCS codes. These problems can sometimes become severe or life-threatening and can lead to death. Avsola *ING-CC-0081. Medical Policy. TE Code RLD RS; TEPEZZA: TEPROTUMUMAB-TRBW: 500MG: INJECTABLE;INJECTION: Prescription: None TBD: No: Approval Date(s) and History, Letters, Labels, Reviews for BLA 761143. MyBlue offers online tools, resources and services for Blue Cross Blue Shield of Arizona Members, contracted brokers/consultants, healthcare professionals, and group benefit administrators. 028: 01/01/2013: Multiple CPT Code Replacements (PDF) CC. Teprotumumab-trbw (Tepezza) binds to IGF-1R and blocks its activation and signaling. Evaluation and Management Services. Tepezza™ NDC #: 75987-0130-15 ASD Healthcare gathers code information from the Centers for Medicare and Medicaid Services (CMS. Other Other Patient has tried and failed the following medication(s):. Dublin, Ireland; Horizon Therapeutics Ireland, DAC, January 2020. Note 2: The absence or presence of a. HCPCS Code Description J3241. Hyperglycemia: Increased blood glucose or hyperglycemia may occur in patients treated with TEPEZZA. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of the policy bulletins is permitted for. KEYTRUDA can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. Note: 1) This list of codes may not be all-inclusive. New HCPCS Codes Effective October 1, 2020. Reported infusion reactions have usually been mild or moderate in severity. Signs and symptoms of infusion-related reactions include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache and muscular pain. CPT Code 92060 for the Sensorimotor Exam: Answers to Your FAQs By Sue Vicchrilli, COT, OCS, OCSR, Academy Director of Coding and Reimbursement; Traci Fritz, COE, Vice Chair of AAPOS Socioeconomic Committee; and Eric A. J0133 Injection, acyclovir. If your test, item or service isn't listed, talk to your doctor or other health care provider. Unlisted procedure, skin, mucous membrane and subcutaneous tissue. About Code Cpt Tepezza. Cpt Tepezza Code. 184: 05/31/2020: Non-obstetrical Pelvic and. Step therapy updates. Avsola *ING-CC-0081. TEPEZZA reduces eye bulging and double vision. There are 61 added codes to describe healthcare equipment and supplies not identified by CPT® codes, as well as nine deleted codes and three revised codes. Service Category CPT/HCPCS Codes Ancillary Services Medicare. About Cpt Code Tepezza. Cpt Code Tepezza. Medicare coverage for many tests, items and services depends on where you live. Removed Crysvita. The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. (ferric derisonmaltose) and Tepezza HCPCS code J1599 previously in effect 11/08/2018 ®Added Panzyga (immune globulin intravenous, human -ifas) 10/09/2018 ™Added Revcovi (elapegademase -lvlr) 10/01/2018. If request is for a dose increase, new dose does not exceed a total of seven 20 mg/kg infusions given every 3 weeks. C-Code effective date: 07/01/2020 J3241 Injection, teprotumumab-trbw, 10 mg. About Cpt Code Tepezza. CPT Code 92060 for the Sensorimotor Exam: Answers to Your FAQs By Sue Vicchrilli, COT, OCS, OCSR, Academy Director of Coding and Reimbursement; Traci Fritz, COE, Vice Chair of AAPOS Socioeconomic Committee; and Eric A. CPT code 99211—which is the E&M code for an established patient, level 1—is bundled with each of the new codes, but both of those CCI edits can be unbundled if both services are medi­cally necessary. Current Procedural Terminology (CPT) and Level II HCPCS codes. Tepezza * Non-oncology use is managed by the medical specialty drug review team. Reimbursement guidelines are developed by clinical staff and include yearly coding updates, periodic reviews of specialty areas based on input from specialty societies and physician committees and updated logic based on current coding conventions. 28, 2020, the Medicaid and NC Health Choice programs cover teprotumumab-trbw for injection, for intravenous use (Tepezza™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics. Max Units (per dose and over time) [HCPCS Unit]: 115 billable units initially followed by 230 billable units every 3 weeks thereafter for a total of 8 doses ; Initial Approval Criteria 1-8,10. The Policies neither constitutes nor substitutes for medical advice. C9077, J3490 ™ Removed Monoferric (ferric derisonmaltose), Tepezza. Teprotumumab (Tepezza™) is a fully human antibody that targets the insulin-like growth factor-1 receptor (IGF-1R) indicated for the treatment of active thyroid eye disease (TED) / Graves' disease in adult individuals 18 years of age and older. Monitor patients with IBD for flare of disease. Register for upcoming CME webinars. Use these alphabetical lists to find Blue Shield medical policies, and review requirements and criteria for new technologies, devices and procedures. References 1. These guidelines provide claims payment editing logic for CPT, HCPCS and ICD-10-CM coding. Infusion reactions may occur during an infusion or within 1. About Code Cpt Tepezza. These codes are primarily billed for Commercial insurances. The CPT®2, HCPCS,3 and ICD-10-CM codes provided are based on AMA or CMS guidelines. Monitor patients with IBD for flare of disease. Brand name Generic name J code National Drug Codes (NDCs) Date of FDA approval Aduhelm aducanumab-avwa J3590 64406-101-01, 64406-102-02 June 7, 2021 Camcevi leuprolide mesylate J9999 NA May 25, 2021 Nexviazyme avalglucosidase alfa-ngpt J3590 58468-0426-1 August 6, 2021 Ryplazim plasminogen human-tvmh J3590 70573-099-01 June 4, 2021. The FDA granted this drug priority review, fast track, breakthrough therapy, and orphan drug designation. 5 hours after an infusion. 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of the day or night. Definition. HCPCS Code Description J3241. Register for upcoming CME webinars. MyBlue offers online tools, resources and services for Blue Cross Blue Shield of Arizona Members, contracted brokers/consultants, healthcare professionals, and group benefit administrators. Avsola *ING-CC-0081. 028: 01/01/2013: Multiple CPT Code Replacements (PDF) CC. ; January 2020. References 1. 5 hours after an infusion. Infusion reactions may occur during an infusion or within 1. Injection, teprotumumab-trbw, 10 mg. Removed Crysvita. The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. The FDA granted this drug priority review, fast track, breakthrough therapy, and orphan drug designation. They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. Service Category CPT/HCPCS Codes Ancillary Services Medicare. Register for upcoming CME webinars. C-Code effective date: 07/01/2020 J3241 Injection, teprotumumab-trbw, 10 mg. Modifier to Procedure Code Validation (PDF) CC. Medical policy determines if, and under what circumstances, medical services may be eligible for coverage. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of the policy bulletins is permitted for. CPT Code 92060 for the Sensorimotor Exam: Answers to Your FAQs By Sue Vicchrilli, COT, OCS, OCSR, Academy Director of Coding and Reimbursement; Traci Fritz, COE, Vice Chair of AAPOS Socioeconomic Committee; and Eric A. The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. TEPEZZA is an insulin-like growth factor-1 receptor inhibitor (IGF-1R) indicated for the treatment of thyroid eye disease (TED). Max Units (per dose and over time) [HCPCS Unit]: 115 billable units initially followed by 230 billable units every 3 weeks thereafter for a total of 8 doses ; Initial Approval Criteria 1-8,10. National Drug Code 75987-130 is assigned to tepezza with active ingredient(s) teprotumumab and is labeled by Horizon Therapeutics USA, Inc. CPT code 99211—which is the E&M code for an established patient, level 1—is bundled with each of the new codes, but both of those CCI edits can be unbundled if both services are medi­cally necessary. , Horizon Insurance Company, and Healthier. 251 Intermittent exophthalmos. Non-Emergent Air Ambulance ; A0430, A0431, A0435, A0436 (Tepezza®) J3241. Tepezza (replaced code C9061) 01/29/21 Addition Incontinence Supplies diapers, wipes, underpads 12/22/20 Addition Genetic testing (S3800,S3840,S3841,S3842,S3846) 03/01/21 Addition. 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of the day or night. Billing Code/Availability Information HCPCS code: J3241 - Injection, teprotumumab-trbw, 10 mg: 1 billable unit = 10 mg NDC: Tepezza 500 mg single-dose vial for injection: 75987-0130-xx VII. 031: 01/01/2013: Never Paid Events (PDF) CC. Signs and symptoms may include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache, and muscular pain. 2020;382 (4):341-352. References. Cpt Tepezza Code. Effective with date of service Jan. Douglas RS, Kahaly GJ, Patel A, et al. Non-Emergent Air Ambulance ; A0430, A0431, A0435, A0436 (Tepezza®) J3241. Note 1: Payment allowance limits subject to the ASP methodology are based on 3Q 2021 ASP data. Behavioral health services. Procedure code J3241 is a replacement for discontinued procedure code C9061, and will have the same prior authorization requirements. DUBLIN--(BUSINESS WIRE)-- Horizon Therapeutics plc (Nasdaq: HZNP) today announced that the U. 251 Intermittent exophthalmos. See Important Safety Information. Accessed February 2021. Note 2: The absence or presence of a. Tepezza (teprotumumab-trbw) is an insulin-like growth factor-1 receptor inhibitor indicated for the treatment of Thyroid Eye Disease. Benefit coverage for health services is determined by federal, state, or contract ual requirements and applicable laws that may. Medical policy determines if, and under what circumstances, medical services may be eligible for coverage. Condition, Keyword, or NCT Number. CPT Code 92060 for the Sensorimotor Exam: Answers to Your FAQs By Sue Vicchrilli, COT, OCS, OCSR, Academy Director of Coding and Reimbursement; Traci Fritz, COE, Vice Chair of AAPOS Socioeconomic Committee; and Eric A. Tepezza 500 mg single-dose vial for injection: 3 vials for initial dose followed by 5 vials for each of 7 additional doses ; B. C9077, J3490 ™ Removed Monoferric (ferric derisonmaltose), Tepezza. It also improves the signs and symptoms of Thyroid Eye Disease (TED), including eye pain, redness, and swelling. Tepezza may cause infusion reactions. To illustrate the CPT coding with a brief example, if total time required for all activities involved for a nurse visit is 2 hours and 40 minutes, coding is: 99601 Billing Unit = 1; 99602 Billing Unit = 1; Medicare and Medical Assistance does not recognize 99601/99602. Teprotumumab for the treatment of active thyroid eye disease. Note 2: The absence or presence of a. For precertification, call (866) 752-7021 (Commercial), (866) 503-0857 (Medicare), or fax (866) 267-3277. Tepezza [package insert]. (A list of codes can be found on page 3, section 12) Alcohol Dependence Opioid Dependence ICD-10 ICD-10 F10. Tepezza Prices. TEPEZZA dosing is based on the patient's actual weight 1. Tepezza (replaced code C9061) 01/29/21 Addition Incontinence Supplies diapers, wipes, underpads 12/22/20 Addition Genetic testing (S3800,S3840,S3841,S3842,S3846) 03/01/21 Addition. TEPEZZA is an insulin-like growth factor-1 receptor inhibitor (IGF-1R) indicated for the treatment of thyroid eye disease (TED). ING-CC-0163. 2020;382 (4):341-352. CPT Code 92060 for the Sensorimotor Exam: Answers to Your FAQs By Sue Vicchrilli, COT, OCS, OCSR, Academy Director of Coding and Reimbursement; Traci Fritz, COE, Vice Chair of AAPOS Socioeconomic Committee; and Eric A. Musculoskeletal policies including hip, knee, shoulder and spine related services. There is a risk of hyperglycemia with teprotumumab-trbw (Tepezza) and, if an individual is diabetic, glycemic control medications may need to be adjusted as appropriate. Member has not received ≥ 8 Tepezza infusions (including the initial 10 mg/kg first infusion); 10. Tepezza ® (Teprotumumab-Trbw The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Erythropoietic protoporphyria Please refer to the ICD-10-CM Manual for a complete description of the diagnosis code. Non-Emergent Air Ambulance ; A0430, A0431, A0435, A0436 (Tepezza®) J3241. Service Category CPT/HCPCS Codes Ancillary Services Medicare. Max Units (per dose and over time) [HCPCS Unit]: 115 billable units initially followed by 230 billable units every 3 weeks thereafter for a total of 8 doses ; Initial Approval Criteria 1-8,10. Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm. Benefit Application. 184: 05/31/2020: Non-obstetrical Pelvic and. Note 2: The absence or presence of a. Please see Full Prescribing Information for more information. Tepezza (teprotumumab-trbw) is an insulin-like growth factor-1 receptor inhibitor indicated for the treatment of Thyroid Eye Disease. About Code Cpt Tepezza. Brand name Generic name J code National Drug Codes (NDCs) Date of FDA approval Aduhelm aducanumab-avwa J3590 64406-101-01, 64406-102-02 June 7, 2021 Camcevi leuprolide mesylate J9999 NA May 25, 2021 Nexviazyme avalglucosidase alfa-ngpt J3590 58468-0426-1 August 6, 2021 Ryplazim plasminogen human-tvmh J3590 70573-099-01 June 4, 2021. Tepezza ® (Teprotumumab-Trbw Listing of a code in this policy does not imply that the service descrbi ed by the code is a covered or non -covered health service. Current Procedural Terminology (CPT®) codes define specific medical procedures performed by physicians. CPT / HCPC Code Drug (Brand Name) Covered Indications / Other Supported Uses Recommended Dosing (where available) • Third dose: 100 mg/kg IV infused over 16 hours; max dose: 10 g/dose. Definition. 28, 2020, the Medicaid and NC Health Choice programs cover teprotumumab-trbw for injection, for intravenous use (Tepezza™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics. ; January 2020. Covid-19 Payment Policy. Lake Forest, IL: Horizon Therapeutics USA, Inc. C9077, J3490 ™ Removed Monoferric (ferric derisonmaltose), Tepezza. Medically Indigent Assistance Program (MIAP) This is a non-Medicaid program. KEYTRUDA is a medicine that may treat certain cancers by working with your immune system. J-Code effective date: 10/01/2020 Applicable NDCs 75987-130-15 Tepezza (teprotumumab) 500mg single-dose vial Applicable Diagnosis Codes. References. • C9061 Injection, teprotumumab-trbw, 10 mg (deleted 09-30-2020) • J3241 Injection, teprotumumab-trbw, 10 mg (effective 10-01-2020) REFERENCES • Tepezza [package insert]. (ferric derisonmaltose) and Tepezza HCPCS code J1599 previously in effect 11/08/2018 ®Added Panzyga (immune globulin intravenous, human -ifas) 10/09/2018 ™Added Revcovi (elapegademase -lvlr) 10/01/2018. Member has not received ≥ 8 Tepezza infusions (including the initial 10 mg/kg first infusion); 5. Home Infusions Description HCPCS Code Medicare Will not pay *. The preamble to the chemotherapy administration section of the CPT Manual is very specific about the circumstances that permit use of these codes (96401-96417). It is an exciting development for those managing and treating thyroid eye disease patients - Ophthalmologists. The NDC must be submitted along with the applicable HCPCS/CPT code(s) and the number of HCPCS/CPT units. 251 Intermittent exophthalmos. Current Procedural Terminology (CPT®) codes define specific medical procedures performed by physicians. PROCEDURES AND BILLING CODES To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD diagnostic codes. CPT code 99211—which is the E&M code for an established patient, level 1—is bundled with each of the new codes, but both of those CCI edits can be unbundled if both services are medi­cally necessary. Non-Emergent Air Ambulance ; A0430, A0431, A0435, A0436 (Tepezza®) J3241. HCPCS codes, descriptions and materials are copyrighted by Centers for Medicare Services (CMS). Tepezza Prices. gov) and the American Medical Association's AAPC CPT® code database. Views: 49603: Published: 11. Because government and other third-party payer coding requirements change periodically, please verify current coding requirements directly with the payer being billed. *If not well tolerated, the minimum infusion duration should remain at 90 minutes. This section contains Medical Policies approved by Blue Cross and Blue Shield of Kansas City ("BCBSKC"). Musculoskeletal policies including hip, knee, shoulder and spine related services. These guidelines are the proprietary information of Highmark. HCPCS or CPT Code(s) Drug *ING-CC-0062. Infusion reactions have been reported in approximately 4% of patients treated with Tepezza. CPT Code 92060 for the Sensorimotor Exam: Answers to Your FAQs By Sue Vicchrilli, COT, OCS, OCSR, Academy Director of Coding and Reimbursement; Traci Fritz, COE, Vice Chair of AAPOS Socioeconomic Committee; and Eric A. Medical policies for Medicare Advantage members: We are required to make coverage determinations for services. 028: 01/01/2013: Multiple CPT Code Replacements (PDF) CC. 251 Intermittent exophthalmos. CPT ® * Code. J0120 Injection, tetracycline, up to 250 mg J0121 Injection, omadacycline, 1 mg J0122 Injection, eravacycline, 1 mg J0129 Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered). CPT code 99211—which is the E&M code for an established patient, level 1—is bundled with each of the new codes, but both of those CCI edits can be unbundled if both services are medi­cally necessary. DRUGS BILLED UNDER MISCELLANEOUS CODES J3490, J3590, J9999 OR C9399 PRIOR AUTHORIZATION COVERAGE INFORMATION. It also improves the signs and symptoms of Thyroid Eye Disease (TED), including eye pain, redness, and swelling. These guidelines provide claims payment editing logic for CPT, HCPCS and ICD-10-CM coding. An October 2020 ASC Fee Schedule (ASCFS) File, an October 2020 ASC Payment Indicator (ASC PI) File, and an October 2020 ASC Drug File will be issued with CR 11963. Signs and symptoms may include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache, and muscular pain. Tepezza Prices. Compliance with glycemic control should be encouraged. CPT code(s) for procedures and other services provided Field 69: Enter ICD-9-CM diagnosis code(s) based on documentation in medical record Field 80: List drug name, XXX (brand/generic) dosage, and NDC Brand (generic), dose, route of administration, NDC XXXXXXXXXXX. For precertification, call (866) 752-7021 (Commercial), (866) 503-0857 (Medicare), or fax (866) 267-3277. Strength/Package Size(s): For Injection: 500 mg lyophilized powder in a single-dose vial for reconstitution Indicated. Durable Medical Equipment. HCPCS Code Description J3241. Providers should report 1 unit for each 1 mg dose provided during the billing period. You should discuss the risks and benefits of using TEPEZZA with your doctor. Medicaid Teprotumumab-trbw (Tepezza) Page 2 of 2 Important note: CODES: Due to the wide range of applicable diagnosis codes and potential changes to codes, an inclusive list may not be presented, but the following codes may apply. Gateway Health Policy Disclaimer. Note: 1) This list of codes may not be all-inclusive. Find enrollment forms, payer access information, and more in this comprehensive resource library. New HCPCS Codes Effective October 1, 2020. Applicable Procedure Codes C9061 Injection, teprotumumab-trbw, 10 mg. Preexisting Inflammatory Bowel Disease: TEPEZZA may cause an exacerbation of preexisting inflammatory bowel disease (IBD). Signs and symptoms of infusion-related reactions include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache and muscular pain. Drugs unclassified injection. Tepezza * Non-oncology use is managed by the medical specialty drug review team. 5 hours after an infusion. Note 2: The absence or presence of a. Code Drug Name 90378 # palivizumab 10 mg (Tepezza) # Unclassified drugs is a list of drugs without a specific HCPCs or CPT code assigned to it-PA is required. You should discuss the risks and benefits of using TEPEZZA with your doctor. In the interim, between July 1 and October 1, a temporary C-code (C9061) has been established for TEPEZZA to support Medicare Fee-for-Service pass-through payment in the hospital outpatient. Benefit Application. References 1. TEPEZZA® (teprotumumab-trbw) is the first and only FDA-approved treatment for this autoimmune condition. ; January 2020. Reimbursement guidelines are developed by clinical staff and include yearly coding updates, periodic reviews of specialty areas based on input from specialty societies and physician committees and updated logic based on current coding conventions. This section contains Medical Policies approved by Blue Cross and Blue Shield of Kansas City ("BCBSKC"). Adult / Pediatric • Herpes simplex encephalitis • Herpes simplex virus (HSV), genital infection (severe). Infusion reactions may occur during an infusion or within 1. The preamble to the chemotherapy administration section of the CPT Manual is very specific about the circumstances that permit use of these codes (96401-96417). Applicable Procedure Codes C9061 Injection, teprotumumab-trbw, 10 mg. General Coding and Billing. Member has not received ≥ 8 Tepezza infusions (including the initial 10 mg/kg first infusion); 10. Medical policy determines if, and under what circumstances, medical services may be eligible for coverage. Unlisted procedure, skin, mucous membrane and subcutaneous tissue. Preexisting Inflammatory Bowel Disease: TEPEZZA may cause an exacerbation of preexisting inflammatory bowel disease (IBD). TE Code RLD RS; TEPEZZA: TEPROTUMUMAB-TRBW: 500MG: INJECTABLE;INJECTION: Prescription: None TBD: No: Approval Date(s) and History, Letters, Labels, Reviews for BLA 761143. 251 Intermittent exophthalmos. Diagnosis Code Description E05. Signs and symptoms of infusion-related reactions include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache and muscular pain. 1, 2020, CMS has added new HCPCS codes (J codes), deleted others and changed the description of some existing codes. Code Description HCPCS. Billing Code/Availability Information HCPCS code: J3241 – Injection, teprotumumab-trbw, 10 mg: 1 billable unit = 10 mg NDC: Tepezza 500 mg single-dose vial for injection: 75987-0130-xx VII. Highmark retains the right to review and revise its medical policy guidelines at its sole discretion at any time without prior notice. 4/1/2021 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products News & Announcements Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Medicare Advantage Members (Updated April 20, 2021). The dose for Infusions 2 to 8 is 20 mg/kg 1. Douglas RS, Kahaly GJ, Patel A, et al. Tepezza * Non-oncology use is managed by the medical specialty drug review team. 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of the day or night. Evaluation and Management Services. About These Policies Medical Policies. C9077, J3490 ™ Removed Monoferric (ferric derisonmaltose), Tepezza. Current Procedural Terminology (CPT®) codes define specific medical procedures performed by physicians. The billing party is solely responsible for coding of services (eg, CPT coding). Tildrakizumab. Original Approvals or Tentative Approvals. Codes listed in the catalog are updated biannually by ASD Healthcare, or more often if necessary. Dublin, Ireland; Horizon Therapeutics Ireland, DAC, January 2020. Preexisting Inflammatory Bowel Disease: TEPEZZA may cause an exacerbation of preexisting inflammatory bowel disease (IBD). Medical policies for Federal Employee Program members: Find them on fepblue. Register for upcoming CME webinars. This list only includes tests, items and services that are covered no matter where you live. HCPCS Level II Code Changes in Effect July 1. The NDC must follow the 5digit4digit2digit format (11-digit billing format, with no spaces, hyphens or special characters). Precertification of teprotumumab-trbw (Tepezza) is required of all Aetna participating providers and members in applicable plan designs. Billing Code/Availability Information HCPCS code: J3241 – Injection, teprotumumab-trbw, 10 mg: 1 billable unit = 10 mg NDC: Tepezza 500 mg single-dose vial for injection: 75987-0130-xx VII. CPT ® * Code. Strength/Package Size(s): For Injection: 500 mg lyophilized powder in a single-dose vial for reconstitution Indicated. Applicable Procedure Codes C9061 Injection, teprotumumab-trbw, 10 mg. Accessed February 2021. Avsola *ING-CC-0081. Please enter keyword or code to search. PATIENT DIAGNOSIS—Please complete the diagnosis code(s) you would like to use by filling in the additional digits. Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm. Compliance with glycemic control should be encouraged. Thyroid eye disease is a rare, autoimmune disease, in which the muscles and fatty tissues behind the eye become inflamed, causing the eyes to be. 251 Intermittent exophthalmos. The NDC must follow the 5digit4digit2digit format (11-digit billing format, with no spaces, hyphens or special characters). Dose does not exceed a single 10 mg/kg dose followed by seven 20 mg/kg infusions given every 3 weeks. You can also view the retired medical policies and out-of-area medical policies. CPT code 99211—which is the E&M code for an established patient, level 1—is bundled with each of the new codes, but both of those CCI edits can be unbundled if both services are medi­cally necessary. Home Infusions Description HCPCS Code Medicare Will not pay *. The NDC must be submitted along with the applicable HCPCS/CPT code(s) and the number of HCPCS/CPT units. KEYTRUDA can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. Douglas RS, Kahaly GJ, Patel A, et al. KEYTRUDA is a medicine that may treat certain cancers by working with your immune system. Find coding info, payer access materials, and more. Crysvita *ING-CC-0162. The purpose of the Horizon Medical Policy Manual is to provide clinical policies applicable to the administration of health benefits insured or administered by Horizon Blue Cross Blue Shield of New Jersey, Horizon Healthcare of New Jersey, Inc. SCDHHS has the responsibility to maintain the manual to be used by county governments and their designees to administer MIAP. These guidelines are the proprietary information of Highmark. 5 hours after an infusion. TEPEZZA is a fully human IgG1 monoclonal antibody. About Code Cpt Tepezza. Tepezza may cause infusion reactions. Gateway Health's Policies should not be construed as providing medical advice or treatment or guaranteeing the outcome or results of any medical services/treatments and/or procedures Providers are responsible for providing medical advice and treatment, are independent contractors, and are. Service Category CPT/HCPCS Codes Ancillary Services Medicare. You should discuss the risks and benefits of using TEPEZZA with your doctor. Centers for Medicare and Medicaid Services (CMS) has assigned a permanent, product-specific Healthcare Common Procedure Coding System (HCPCS) J-code (J3241) for TEPEZZA ® (teprotumumab-trbw), the first and only FDA-approved medicine for the treatment of Thyroid Eye Disease (TED). Register for upcoming CME webinars. gov) and the American Medical Association's AAPC CPT® code database. Infusion reactions have been reported in approximately 4% of patients treated with Tepezza. Current Procedural Terminology (CPT) and Level II HCPCS codes. Medical policies are used by all plans and lines of business unless Federal or State law—as well as contract language, including definitions and specific contract provisions.