CODING & REIMBURSEMENT FREQUENTLY ASKED QUESTIONS
The most asked questions about coding & reimbursement for Venofer
Venofer Reimbursement Brochure and Patient Assistance Program
Venofer Reimbursement Brochure and Patient Assistance Program
This guide provides information about general coverage, coding, and reimbursement to help healthcare providers understand the policies of the Medicare program and other third-party payers. Information is also provided on the VenAccess™ Patient Assistance Program.
DownloadBagging" generally means that a third party—eg, a pharmacy—provides the drug either to the patient or to the treating health care provider, as opposed to the health care provider receiving the drug from the treating health care provider.
a. "Brown Bagging" is when a patient's insurance company instructs a specialty pharmacy to ship the drug to the patient and the patient brings the drug to their chosen healthcare facility for administration to the patient. When insurance companies do this, they do not reimburse the healthcare facility for the cost of the drug because the drug was already purchased from the specialty pharmacy and, therefore, the provider does not need to be reimbursed for the drug.
b. "White Bagging" is when a patient's insurance company (rather, the insurer’s designated specialty pharmacy) ships the drug to the patient's chosen healthcare facility for administration to the patient. Similar to brown bagging, insurance companies do not reimburse the healthcare facility for the cost of the drug because the drug was already purchased from the specialty pharmacy and, therefore, the provider does not need to be reimbursed for the drug.
c. "Clear Bagging" is when a patient's chosen healthcare facility offers its own pharmacy, and the provider accesses the drug from that pharmacy rather than a distributor. This happens either because the patient has only a pharmacy benefit and no major medical benefits (for office-based infusions) or the drug is only covered under the pharmacy benefit.
CPT code | CPT code descriptor |
---|---|
96374 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug (15 minutes or less) |
96375 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, separate or sequential substance/drug (15 minutes or less) |
96365 | Intravenous infusion for therapy, prophylaxis, or diagnosis (specify substance or drug); initial up to 1 hour (16-90 minutes) |
96367 | Intravenous infusion for therapy, prophylaxis, or diagnosis (specify substance or drug); separate or sequential substance/drug (16-90 minutes) |
96366 | Intravenous infusion for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour, up to 8 hours (list separately in addition to code for primary procedure; 30 minutes into the next hour) |
J1756 Injection, Iron Sucrose, 1 mg
Each 1 mg of Venofer is equivalent to one (1) service unit. When billing for quantities greater than 1 mg, indicate the total amount used as a multiple of service units on the claim form. Service units are very important and must be included on every claim.
Here are some Venofer examples:
• One (1) vial (2.5 mL) or 50 mg = 50 service units
• One (1) vial (5 mL) or 100 mg = 100 service units
• One (1) vial (10 mL) or 200 mg = 200 service units
XXXXX-XXXX-XX
Venofer is preservative free and available as 50 mg/2.5 mL single-use vials, 100 mg/ 5 mL single-use vials, and 200 mg/10 mL single-use vials.
NDC | Vial Size |
---|---|
00517-2325-10 | 2.5 mL Single-Dose Vial (50 mg) (10/pack) |
00517-2340-10 | 5 mL Single-Dose Vial (100 mg) (10/pack) |
00517-2340-25 | 5 mL Single-Dose Vial (100 mg) (25/pack) |
00517-2340-99 | 5 mL Single-Dose Vial (100 mg) (10/pack) Premier ProRx |
00517-2310-05 | 10 mL Single-Dose Vial (200 mg) (5/pack) |