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Thread: New Drug

  1. #1
    Join Date
    Apr 2007

    Default New Drug

    AAPC: Back to School
    Has anyone billed for Yervoy ? New drug very expensive.

  2. #2
    Join Date
    Apr 2007
    Bettendorf, Iowa

    Red face

    We decided not to give it yet because of the expense and with it being a dump code yet....we're going to hold off til we hear from a few other hem/onc practices to see if they have problems with reimbursement.

    Its hard being the first one out of the gate on new drugs especially when our cost is the price of a new car.
    Last edited by relong; 05-11-2011 at 11:11 AM.
    Ruth Long CPC,CHONC

  3. #3


    Yes, our facility has billed one so far, have not heard back yet on the reimbursement.

  4. #4
    Join Date
    Apr 2007


    We billed this drug and we were actually paid!

  5. #5

    Default Yervoy???

    Quote Originally Posted by kmasters View Post
    We billed this drug and we were actually paid!
    If we administered 300mg to the patient using a 200mg vial and (2) 50mg vials.....how would we bill this?

    On two lines showing each so that we could accurately report the NDC #?

  6. #6
    Join Date
    Apr 2007

    Default yerway

    I would bill one unit with the total price of the drug. and report the ndc numbers for the 200 mg vial and the ndc number for the 50 mg vials using 2 vials.

  7. #7
    Join Date
    Apr 2007

    Default Yervoy

    We are giving Yervoy and are consistently being underpaid by Highmark Blue Shield - We are billing as J9999 with the NDC number and Blue Shield keeps underpaying even though I sent a paper claim with their allowed amount attached. We always have to do an appeal to get the full allowed amount.

    Any suggestions for how to get them to pay claim correctly with the first claim submission?

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