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INSIDE THIS ISSUE Code Updates: Large Price Changes New HCPCS® Codes and Changed Code Descriptions Effective January 1, 2019 CMS News: CMS Final Ruling on Medicare Physician Schedule Effective January 1, 2019 Drug Reimbursement Code Price Updates: 47 Drug Codes required a recalculation of their AWP Code Price Drugs/Devices: New Clinical and Billing Information CODE UPDATES Large […]

New Drug Overview – emapalumab-lzsg (Gamifant®) On November 20, 2018, the U.S. Food and Drug Administration (FDA) approved emapalumab-lzsg (Gamifant®) for the treatment of pediatric (newborn and above) and adult patients with primary hemophagocytic lymphohistiocytosis (HLH) who have refractory, recurrent or progressive disease or intolerance with conventional HLH therapy. Primary HLH is an ultra-rare disease, […]

In November there were a total of eight new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were five supplemental drug approvals. The FDA had assigned five new products for review. Drugs included in this review are generally regarded by the industry as specialty drugs.  Qualifiers may include […]

Whether the product comes in a single or multi-dose vile can also affect billing units. In this example, there is one billing unit contained in a single-dose vial, and 10 billing-units are contained in a multi-dose vial. In this case, it is helpful that the NDCs cross-walk back to different codes. Conversion factors are often incorporated […]

You have to take into account multiple considerations based on the NDC that is being billed, such as the dose for a pediatric patient billed differently from an adult dose, so each may crosswalk to a unique code. Whether the NDC designates a single dose or a multi-dose vile could affect the unit conversion.   […]

FDA Approval: 11/2/18 Febrile neutropenia is a complication that can occur in cancer patients receiving chemotherapy. Normally, neutrophils (a type of white blood cell) protect against infections; however, chemotherapy treatments may cause a reduction in neutrophils to abnormal levels in cancer patients, known as neutropenia. When significant neutropenia occurs in the presence of a fever, […]

When we are dealing with code level data, important basics include the billing of the correct units and making sure that you are billing under the correct code. For this year, seven brands of quadrivalent vaccines are available, but due to different properties including dose, 28 individual NDCs crosswalked back to 9 different codes.   This […]

INSIDE THIS ISSUE Code Updates: Update -J-Code 1599 Addition of 12 active NDCs Update- Removal of minimum and maximum dosing for J1325 and J3285 Update- Revision of maximum dose for J2278  CMS News: Medicare Influenza Vaccine Pricing 2018-2019 Season NEW Influenza CPT® Code 90689 Effective January 1, 2019 NEW HCPCS® Codes and Changed Code Descriptions […]

Hello. I am Wendy Sullivan, Director of Drug Informatics for RJ Health. I’d like to welcome you to today’s webinar-Creating Pre-Payment Controls for Medically Covered Drug Costs through Automation. Before we get started, I’d like to thank you for attending and to thank my colleagues who helped make this webinar possible. In terms of my […]

New Drug Overview – levoleucovorin (Khapzory™) On October 19, 2018, the U.S. Food and Drug Administration (FDA) approved levoleucovorin (Khapzory™) for three indications. Rescue after high-dose methotrexate therapy in patients with osteosarcoma. Diminishing the toxicity associated with overdosage of folic acid antagonists or impaired methotrexate elimination. The treatment of patients with metastatic colorectal cancer in […]