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Thread: Prolia plus injection

  1. #1

    Default Prolia plus injection

    AAPC: Back to School
    We are having a hard time getting reimbursed from humana for the prolia plus injection. Has anyone had any issues on this or have any information about how to get this paid???

  2. #2
    Join Date
    Apr 2007


    Humana is the worst to try to get reimbursement for Prolia. What we had to do was fill out a Prior Auth form from Humana and submit that to them so they could review documentation and provide an Auth number. This was in addition to having Prolia Plus send in for verification. It took us over 6 months to get one injection paid and that was after we had appealed the claim.

    I hope this helps.
    Teresa Collins, CPC

  3. #3

    Default Prolia

    Ok thank you for the comments, also what code did you guys submitt it under the c-code or the j-code

  4. #4
    Join Date
    Apr 2007


    We use J3490 and include the description with the NDC; and, of course, the administration CPT 96372.

    I hope this helps.
    Teresa Collins, CPC

  5. #5

    Default Tda, ba, cpc

    Directly from the Prolia drug representatives, we use J3590 and 96372 with no denial issues thus far.

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