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Prolia the new osteoporosis drug

  1. #21
    Medical Coding Books
    You are welcome!
    Teresa Collins, CPC

  2. #22
    Post Can anyone tell me if BCBS and Aetna are covering the prolia
    Quote Originally Posted by DebbiePotts View Post
    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.

    Can anyone tell me if BCBS and Aetna are covering the prolia?

  3. Default Sandra Ebert
    We gave a Prolia injection in August 2010 and still having trouble with
    Medicare. Does anyone have a Medisoft medical computer program?
    Can't seem to get strength and dosage in. Tried consultants, vendors etc.

  4. Smile Prolia
    We are using C9272(Denosumab 60mg/ml)

  5. Default
    Did anyone ever post which admin code is used with Xgeva?

  6. Default Prolia
    code for prolia is C9272 60 units

  7. Default Xgeva
    J3490, J350, depending on the payor or C9272 with 120 mg

  8. Cool Prolia
    Could someone enlighten me on code C9272? Can this code be used if given in the office or is this code only to be used if patient in out patient hospital setting?

  9. Default Prolia
    Code C9272 is a pass-through code and should only be used by hospital outpatient departments. If you are billing in an office setting, use J3590 or J3490.

  10. Default
    Quote Originally Posted by aabbott View Post
    We 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.
    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 settings

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