Wiki Ameluz J7345

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Sarahp941

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I'm not sure if this is the right place to ask, but I am still searching for reimbursement information for Ameluz. I cannot find any pricing, anywhere. Even Medicare has not updated their MPFS or ASP Drug list for Ameluz. We have started using this product for our PDT's. Any help would be appreciated! Thanks
 
The manufacturer should be able to give you guidance. If they have a rep who comes to your office, start with him/her. Otherwise, call the company.
 
I have a free mini-webinar I published on the 2018 PDT coding/billing changes including Ameluz.

It's on demand (just enter your info) and comes with a great 10-page handout

https://register.gotowebinar.com/register/5365322466582127618

CMS has not yet released national reimbursement rates for J7345 in the 2018 Medicare drug fee schedule. The manufacturer, Biofrontera, is working with the various Medicare contractors (MACs) and CMS to standardize billing and reimbursement between all payors.

Important: Each J-code unit for J7345 is per 10 mg. 1 tube of Ameluz® contains 2 grams, or 2000 milligrams of product. Therefore, for application of an entire tube to a patient, J7345 is billed at 200 units.

It is anticipated that the 106% Average Wholesale Price (AWP) reimbursement for Medicare will be $1.431 per unit. Billing 200 units of J7345 (one tube) would therefore be $286.20.

Source: http://www.biofrontera.us.com/reimbursement/
http://www.biofrontera.us.com/wp-content/uploads/2018/01/JCode-info.pdf

Note: This new J-code (J7345) is now billable with PDT codes 96567, 96573, and 96574.
 
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