Reimbursement

Evrysdi Sample Coding

This coding information may assist you as you complete the payer forms for Evrysdi. These tables are provided for informational purposes only. 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.

Download sample coding and the important safety information for Evrysdi below. "Download All" lets you download and print the coding tables for all indications.

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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 does not make any representation or guarantee concerning reimbursement or coverage for any service or item.

Appeals

If your patient's health insurance plan has issued a denial, your Neurological Rare Disease Therapeutic Area Manager (NRD TAM) or Case Manager (CM) can provide general resources as you prepare an appeal submission, as per your patient's plan requirements.

If a plan issues a denial:

  1. The denial should be reviewed, along with the health insurance plan's guidelines to determine what to include in your patient's appeal submission.
  2. Your NRD TAM or CM has local payer coverage expertise and can help you determine specific requirements for your patient.

A sample appeal letter and additional considerations for appeals are available in Forms and Documents.

Appeals cannot be completed or submitted by MySMA Support for Evrysdi on your behalf.