Hyalgan reimbursement guide2Table of ContentsIMPORTANT SAFETY INFORMATIONHYALGAN is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy and to
simple analgesics (eg, acetaminophen)HYALGAN is contraindicated in patients with known hypersensitivity to hyaluronate preparations.Intra-articular injections are contraindicated in
cases of present infections or skin diseases in the area of the injection site to reduce the potential for developing septic arthritis The effectiveness of a single treatment cycle of less than 3 injections has not been established In the US clinical trial of 495 patients, the only adverse event showing statistical signicance
vs placebo was injection-site pain Other adverse events included gastrointestinal complaints, headache, local ecchymosis and
rash, local joint pain and swelling, and local pruritus.However, the incidence of these events was similar in the HYALGAN-treated and placebo groups In other clinical studies, the frequency and severity of adverse events occurring during repeat treatment cycles did not increase over that reported for a single treatment cyclePlease see full Prescribing Information for more details.HYALGAN Support Hotline: 1-866-7HYALGAN (1-866-749-2542)The HYALGAN Support Hotline does not le claims or appeal claims for callers, nor can it guarantee that you will be successful in obtaining reimbursement.Third-party payment for medical products and services is affected by numerous factors, not all of which can be anticipated or resolved by the hotline.3TABLE OF OF REIMBURSEMENT
5HYALGAN PUBLIC AND PRIVATE PAYER COVERAGE INFORMATION
Private REIMBURSEMENT IN THE PHYSICIAN OFFICE , HCPCS, CPT
CMS-1500 Sample Claim REIMBURSEMENT IN THE HOSPITAL OUTPATIENT , HCPCS, CPT, ICD-9-CM Procedure Codes, Revenue Codes ....14
CMS-1450/UB-04 Sample Claim REIMBURSMENT SUPPORT & PATIENT ASSISTANCE RESOURCES
19The HYALGAN Support Hotline
Reimbursement Support Program
Patient Assistance Program
19Claims and Appeals Checklists
Benet Verications and Prior Claims and Appeals
Sample Letter of Medical Necessity
Sample Letter of Appeal
234Table of ContentsINTRODUCTIONDescription and IndicationHYALGAN is a viscous solution consisting of a high-molecular-weight (500,000 to 730,000 daltons) fraction of puried national sodium hyaluronate (Hyalectin) in buffered physiological sodium chloride, with a pH of 6.8 to 7.5.
Sodium hyaluronate is extracted from rooster combs.
Hyaluronic acid is a natural complex sugar of the glycosaminoglycan family and is a long-chain polymer containing repeating disaccharide units of is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy and to simple analgesics (eg, acetaminophen).Please see full Prescribing Information for additional details.Dosage and AdministrationHYALGAN is administered by intra-articular injection.A treatment cycle consists of 5 injections given as 1 injection per week for 5 weeks.
Some patients may experience benets with 3 injections given as 1 injection per week for 3 weeks.This has been noted in studies reported in the literature in which patients treated with 3 injections were followed for 60 days.Please see full Prescribing Information for additional details.Using the HYALGAN Reimbursement GuideThe HYALGAN Reimbursement Guide is intended to provide current and available reimbursement information related to HYALGAN in the physician ofce and hospital outpatient settings of care when HYALGAN is administered as prescribed by a healthcare professional.
In this document, coverage, coding, and payment for HYALGAN are reviewed for public (Medicare/Medicaid) and private payers.In addition, the reimbursement support and patient assistance services available through The HYALGAN Support Hotline are described.Lastly, reimbursement support tools such as sample claim forms, checklists, and template letters are provided to assist healthcare providers and
staff when utilizing HYALGAN for patient therapy.Disclaimer Information described in the HYALGAN Reimbursement Guide is intended solely for use as a resource tool to assist physician ofce and hospital outpatient billing staff regarding reimbursement issues.
Any determination regarding if and how to seek reimbursement should be made only by the appropriate members of the physician ofce or hospital outpatient staff, in consultation with the physician, and in consideration of the procedure performed or therapy provided to a specic patient.Fidia Farmaceutici S.p.A/Interpace BioPharma do not recommend or endorse the use of any particular diagnosis or procedure code(s) and make no determination if or how reimbursement may be available.Of important note, reimbursement codes and payment, as well as health policy and legislation, are subject to continual change; information contained in this version of the HYALGAN Reimbursement Guide is current as of September 2011.Information provided in the HYALGAN Reimbursement Guide is for your guidance only.
The HYALGAN Support Hotline does not le or appeal claims for callers, nor can it guarantee reimbursement by third-party payers.For details on the specic services provided by The HYALGAN Support Hotline, please see the nal section of the HYALGAN Reimbursement Guide.Reimbursement specialists at The HYALGAN Support Hotline are available to assist you with questions related to reimbursement support and access services for therapy with HYALGAN.To contact a reimbursement specialist, please call 1.866.7.HYALGAN (1.866.749.2542), Monday to Friday, from 9:00 am to 8:00 pm EST
.5Table of Content
Intra-articular Injections Of Hyaluronan (inj-033) Billing And ...
... Hyalgan or Supartz, ... The aspiration and/or injection procedure code may be billed in addition to the drug. ... the injection procedure (CPT 20610). (hyalgan.com)
Intra-articular Hyaluronan Injections For …
articular injection of HA (IA-HA), ... Hyalgan, Fidia; Supartz, ... of a code does not constitute or imply member coverage or provider (downloads.cms.gov)
Medicare Cpt/hcpcs Update All Payers Workshop
Q4079 Natalizumab injection D See J2323 Q4083 Hyalgan/supartz inj per dose D See J7321 ... • Pharmacologic management (CPT code 90862); and (notes.bluecrossmn.com)
012010 00115 l30149 inj033 cbgIntra-articular Injections of Hyaluronan (INJ-033) Billing and Coding Guidelines
1.HCPCS code J7321, J7323, and J7324 are per dose codes.
When the injections are administered bilaterally, list J7321, J7323 or J7324 in item 24 (FAO-09 electronically) with a 2 in the units Hyaluronan or Derivative, Hyalgan or Supartz, For Intra-Articular Injection, Per DoseJ7323 Hyaluronan or Derivative, Euflexxa, For Intra-Articular Injection, Per DoseJ7324 Hyaluronan or Derivative, Orthovisc, For Intra-Articular Injection, Per Dose2.HCPCs code J7325 is defined as 1 mg J7325 Hyaluronan or Derivative, Synvisc or Synvisc-One, For Intra-Articular Injection, 1mg
When this injection is administered either unilaterally or bilaterally the injections would be billed by placing J7325 in item 24 (FAO-09 electronically) and listing the total number of mgs administered in the units field.
There are 2 different products that are billed using this code.
Synvisc - (16mg/2ml) injection is given once a week (i.e., at seven-day intervals) for a total of Synvisc-One- (48mg/6ml) - single dose injection
3.The aspiration and/or injection procedure code may be billed in addition to the drug.
Indicate which knee was injected by using the RT (right) or LT (left) modifier (FAO-10 electronically) on the injection procedure (CPT 20610).
Place the CPT code 20610 in item 24D.
If the drug was administered bilaterally, a -50 modifier should be used with 20610.
When this drug is administered in the hospital (inpatient or outpatient) setting, the drug/visco supplementation would not be covered by Part B.
It would be covered under the Part A benefit.5.Evaluation and management service: a.An E&M service may be appropriate if the made after an evaluation during the same visit.
Indicate this by using an E&M code with modifier -25.b.After the first injection, during the visitsnot be covered unless there was a separately identifiable problem for which the E&M service was required and rendered.
6.When additional substances are concomitantly administered (e.g.cortisone, anesthetics) with viscosupplementation, only one injection service is allowed per knee.
If the drug is denied as not reasonable and necessary, the associated injection code is also not 8.We suggest that the entire series of injections be billed on the same claim form.
Article 02/01/2010Article 01/01/10Article 10/01/0909/01/09 02/01/2010- Removed code J7325 from coding instruction #1 and added #2, renumbered document.Annual code updates-Added J7325, Deleted J7322; Added Per JSM 09414 08-13-09 new instructions for hospital billing of Synvisc-One: For services provided betweenFebruary 26, 2009, through December 31, 2009, contractors shall instruct hospitals to bill for Synvisc-One using three (3) units of the Healthcare Common Procedure Coding System (HCPCS) Code J7322 (Hyaluronan or derivative, Synvisc, for intra-articular injection, per dose).
The instructions for billing NOC codes (J3490 and C9399) have been removed.
All settings should bill Synvisc-One as 3 units of code J7322..
Intra articular hyaluronan injections for osteoarthritisMedical and Behavioral Health Policy Manual Policy Number:
03/28/2012 Hyaluronan (HA), also known as hyaluronate or hyaluronic acid, is a naturally occurring macromolecule that is a major component of synovial fluid and is thought to contribute to its viscoelastic properties.Chemical crosslinking of hyaluronan increases its molecular weight; crosslinked hyaluronans are referred to as hylans.In osteoarthritis, the overall length of hyaluronan chains present in cartilage and the hyaluronan concentration in the synovial fluid are decreased.Intra-articular injection of HA (IA-HA), known as viscosupplementation, has been proposed as a means of restoring the normal viscoelasticity of the synovial fluid in patients with osteoarthritis.
Five preparations of intra-articular hyaluronan (Synvisc, Biomatrix; and Euflexxa, previously named Nuflexxa, Savient) have been alternative to NSAID therapy in the treatment of osteoarthritis of the knee.
All products are manufactured from rooster combs except for Euflexxa, which is the only non-avian derived hyaluronan approved in the United States.
Also, Synvisc undergoes additional chemical crosslinking to create hylans with increased molecular weight compared to Hyalgan and Supartz.The differing molecular weights of the products lead to different half-lives; the half-life of Hyalgan or Supartz is estimated at 24 hours, while the half-life of Synvisc may range up to several days.Intra-articular hyaluronic acid is indicated for the treatment of pain in osteoarthritis of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy, and to simple analgesics (e.g., acetaminophen).The product inserts indicate that Synvisc and Euflexxa should be injected intra-articularly into the knee joint once per week for a total of 3 injections over a 2- to 3-week period.In contrast, 5 weekly injections are recommended for the Hyalgan and Supartz products, and 34 weekly injections are recommended for OrthoVisc.The FDA approved removal of a precautionary statement from the package inserts for sodium hyaluronate (MW 500-730 kDa) and hylan G-F 20 that stated that the safety and efficacy of repeat courses have not been established.In February 2009, the FDA approved the use of single-dose hylan G-F 20 Policy History: Policy Committee Review: Reviewed March 11, 2009 Revised Coverage Section May 15, 2009 (single dose injection) Revised March 10, 2010 Reviewed March 9, 2011 Coding Updated January 3, 2012 Reviewed March 14, 2012 Medical Policy Committee Review: Current Procedural Terminology ) is copyright 2011 American Medical Association.All Rights Reserved.No fee schedules, basic units, relative values, or related listings are included in CPT.The AMA assumes no liability for the data contained herein.
Applicable FARS/DFARS restrictions apply to government use..
Tags: cpt code for synvisc injections,supartz injection cpt code,hyalgan national drug code,how to bill for hyalgan,hcpcs code for supartz,