The Prolia injection is for osteoporosis. We have some literature that was given to us by the pharmaceutical rep that I will be happy to email to you. If you are interested in it, please provide me your email address and I'll send it to you.we are not using it for chemo and I was not aware that it was a chemo drug. We are using it for osteoporosis, If I remember correctly. As of now we have not started using it. they are thinking about it. I would like to know what you are using it for. and if you have literature that you can share.
Can anyone tell me if BCBS and Aetna are covering the prolia?I have been looking for a HCPCS code for Prolia. It is a new drug and I am thinking I am going to have to use J3490 (unlisted code). I would appreciate any help.
xgeva is only for cancer related conditions, not "regular" osteoporosis such as senile osteoporosis in which case the larger reimbursement is not valid. FCSO recognizes the J code and reimbursement is in the $860's- also include your office injection code for the office settingsWe are actually using the brand name Xgeva. We are using the J3590, unclassified biologic. Also, our Medicare allowed is $1744.68 per dose. Remember that one dose of denosumab is 120mg (1 vial = 120mg) and therefore you will only bill for one unit. So be sure to set up fee schedule based on that. I found a pdf file that was very helpful on the Amgen Assist website.
Another note on the coding, we found out recently that Cahaba Medicare did not like the J3590 and requested the J9999 instead.
I hope this helped.