This table is provided for informational purposes only. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech and Novartis Pharmaceuticals Corporation do not make any representation or guarantees concerning reimbursement or coverage for any service or item.
Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding for single-use vials and wastage.
Moderate to Severe Persistent
|493.00||Extrinsic asthma, unspecified†|
|493.20||Chronic obstructive asthma, unspecified†|
Chronic Idiopathic Urticaria
|708.8||Other specified urticaria†|
|50242-040-62||50242-0040-62||150-mg single-use vial|
|Drug: HCPCS2§||J2357||Injection, omalizumab, 5 mg|
|Select Procedures, Services and Supplies: CPT||||96372||Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular¶|
|96401||Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic#|
|*||International Classification of Diseases—9th revision—Clinical Modification.|
|†||This description corresponds to the ICD-9 codes as determined by the Centers for Medicare & Medicaid Services. Please refer to the XOLAIR indications below.|
|‡||National Drug Code.|
|§||Healthcare Common Procedure Coding System.|
|||||Current Procedural Terminology (CPT®).|
|¶||XOLAIR is for subcutaneous use. Please refer to the XOLAIR indications below.|
|#||XOLAIR is not an anti-neoplastic agent. Please refer to the XOLAIR indications below.|
National Center for Health Statistics and the Centers for Medicare & Medicaid Services. The International Classification of Diseases, 9th Revision. Clinical Modification (ICD-9-CM), 6th edition. Hyattsville, MD: US Dept of Health and Human Services; 2011.
Centers for Medicare & Medicaid Services. 2013 table of drugs. http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Downloads/DRUG2013.pdf. Accessed December 4, 2013.
If your office has prescribed XOLAIR® (omalizumab) for appropriate patients, but your patient’s insurer has denied coverage, you can appeal that decision. XOLAIR Access Solutions and the XOLAIR Specialty Pharmacy Network might be able to help you as you resolve the situation. Here is what you can do*:
|*||This description of the appeals process is for informational purposes only. The submission of an appeal is the responsibility of the patient and your office. XOLAIR Access Solutions makes no representation or guarantee concerning coverage or reimbursement for any service or item. Each health plan and patient case may require different information. Please review each denial and the health plan’s guidelines to determine what to include in your patient’s appeal package.|