Wiki Durysta

[jhooker]

Is anyone using Durysta? The code is J3510 and is for 1 mcg. The injection comes as 10 mcg's and that is what is injected. Thus, it is billed with 10 units. Anthem paid for one unit even though it was billed correctly as 10 units. Any suggestions on how to get Anthem to pay correctly?

 

[jessicaw412@gmail.com]

We are billing Durysta done in the office with code J7351 with 10 units per the Billing Guide provided by Durysta, I have attached the guide we have, your rep should be able to provide this info as well. We have not done this on any commercially insured patients as of yet, but we do have an Anthem Medicare patient scheduled within the next few weeks. We have had fully approved claims from Medicare Indiana and Humana Medicare. We also process all of our patients through the Allergan EyeCue program prior to scheduling them for Durysta. We find this helpful since they will provide us a a coverage detail and info regarding how to initiate precert/pre-determ if needed. I would reach out to your local rep and they should be able to hook you up with a reimbursement specialist to help also.