Researchers found half of patients taking the biosimilar infliximab-dyyb (Inflectra) remained highly adherent to medication use after 12 months.
Rheumatology Coding Corner Answer: Billing for an Inflectra Infusion
Take the challenge. CPT codes: 96413, 96415, 96375, Q5103x20, J1200 ICD-10: M07.9 Coding Rationale This procedure is billed with CPT code 96413 for the initial hour of the intravenous infusion and CPT code 96415 for each additional hour. The patient was given 50 mg of diphenhydramine prior to the infusion to prevent reactions and should…
Rheumatology Coding Corner Question: Billing for an Inflectra Infusion
A 68-year-old female patient returns to the office for a second round of Inflectra (infliximab-dyyb) infusion for her rheumatoid arthritis with rheumatoid factor of multiple joints without organ or systems involvement. She reports pain, stiffness and swelling in her left and right knees and right elbow and rates the pain at a 9 on a…
Health Plans Enact Coverage Policies for Remicade & Infliximab Biosimilars
Several major health plans have recently enacted policies regarding coverage status for Remicade (infliximab) and its biosimilars, Inflectra (infliximab-dyyb) and Renflexis (infliximab-abda). Most of these plans are limiting coverage for the biosimilar products to very specific circumstances. Some have also begun denying claims for biosimilars and instructing patients to switch to Remicade. The plans implementing…
Pfizer Announces Medicare Reimbursement for Inflectra (infliximab-dyyb), the First Biosimilar Monoclonal Antibody Available in the United States
On Jan. 6, Pfizer Inc. announced that the Centers for Medicare and Medicaid Services (CMS) has included payment information for INFLECTRA (infliximab-dyyb), a biosimilar to REMICADE (infliximab), in its January Average Selling Price (ASP) pricing file. This pricing took effect as of January 1, 2017. Additional claims processing information is listed in the MLN Matters…