Wiki How to bill Xolair Prefilled Injection ? Is there same J-Code J2357 for billing?

[pushp4aapc]

Hi,

Please help me with one of my questions. Actually, I want information for Xolair Prefilled Injection billing.

Can we bill this same as previously like with J2357 or there is any other J-Code for this?

If any modifier or other Administration code for Prefilled Xolair Injection Billing then please help me to give the answer on this post.

Thanks in advance!

 

[trarut]

J2357 is the HCPCS code for the prefilled syringe or vial.
Regarding the administration, you don't specify the route so, assuming it is a subcu/IM injection, use 96372. Whether a modifier is needed or not is for you to determine based on any other services billed by your office on the same day.

 

[pushp4aapc]

Thank you, Traut, for your reply.

As I understand from your response that there is no other code for Xolair Prefilled Syringe, Am I right?

So for Xolair Prefilled Syringe if it gave IM/Subcu then it can bill like:

J2357
96372

It means for Xolair Prefilled syringe also billed like the General Xolair Injection Billing?

Please give me confirmation if I am right and If I am wrong then please correct me.

Thank you!

 

[trarut]

That is correct. The same HCPCS code - J2357 - is used if you use the vial dosing or prefilled syringe. Just be careful to calculate the correct number of units as the HCPCS code is 5 mg/billing unit.

You can usually find this information on the drug manufacturer website. The link for the Xolair site is here. If you click the + to expand either indication, you'll see they list both the prefilled syringe and vial NDCs.

 

[pushp4aapc]

Hey Trarut,

Thank you very much for this valuable information.

I really appreciate for your valuable time and kind help.

 

[trarut]

No problem, pushp4aapc! Hope it helps

 

[mmcquillen@susquehannahealth.org]

Is J2357 ever billed with 96401? TIA

 

[rachaelwilleford]

Is J2357 ever billed with 96401? TIA

Some physicians/payers consider this to be a complex biological drug hence the 96401. Check your payer policy regarding Xolair for appropriate administration code.

 

[tdbailey]

Does anyone have experience billing for 225mg of Xolair? We are having issues billing for 150mg prefilled and 75mg using two line items since there are different lot numbers.

Example: J2357 with 30 units (prefilled 150mg)
J2357 with 15 units ( prefilled 75mg)
96372 for admin
Patient receives a total of 225 mg of Xolair. Looks like some insurance companies are denying the prefilled 75mg for a duplicate even though the lot and NDC numbers are different.