Coding and Reimbursement

Hemophilia A Treatment Reimbursement

CSL Behring provides a range of reimbursement services for hemophilia A patients, including individual claims processing reviews, assistance in appeals, insurance investigations into product coverage, and prior approvals for therapies authorization. To speak with a representative, call the Reimbursement Answerline at 1-800-676-4266 Monday through Friday from 8 a.m. to 5 p.m. ET. Or, visit our online Reimbursement Resource Center.

BILLING CODES
HCPCS CODE1 ICD-10-CM2,3 CPT CODES
J-7192- FACTOR VIII (ANTIHEMOPHILIC FACTOR RECOMBINANT), PER IU D66 - HEREDITARY
FACTOR VIII
DEFICIENCY
96374
96376
96365

This hemophilia resource provides information from a complex and evolving medical coding system. The treating physician is solely responsible for diagnosis coding and determination of the appropriate ICD-10-CM codes that describe the hemophilia A patient’s condition and are supported by the medical record. All codes listed in this guide are for informational purposes and are not an exhaustive list. The CPT, HCPS, and ICD-10-CM codes provided are based on AMA or CMS guidelines. The billing party is solely responsible for coding of services (eg, CPT coding). Because government and other third-party payor coding requirements change periodically, please verify current coding requirements directly with the payor being billed.

NDC CODES
CODE DESCRIPTION
NDC 0053-8131-02 Approximately 250 IU per bottle
NDC 0053-8132-02 Approximately 500 IU per bottle
NDC 0053-8133-02 Approximately 1000 IU per bottle
NDC 0053-8134-02 Approximately 2000 IU per bottle
NDC 0053-8135-02 Approximately 3000 IU per bottle
References:
  1. https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-PCS-and-GEMs.html
  2. http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2015
  3. http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html

Disclaimer: This resource provides information from a complex and evolving medical coding system. The treating physician is solely responsible for diagnosis coding and determination of the appropriate ICD-10 CM codes that describe the patient’s condition and are supported by the medical record. All codes listed are for information purposes and are not an exhaustive list. The CPT, HCPCS and ICD-10-CM codes provided are based on AMA or CMS guidelines. The billing party is solely responsible for coding of services (eg, CPT coding). Because government and other third-party payer coding requirements change periodically, please verify current coding requirements directly with the payer being billed.

Important Safety Information

You should not use Helixate FS if you are allergic to rodents (like mice and hamsters) or are allergic to any ingredients in Helixate FS.

Tell your healthcare provider if you have been told you have heart disease or are at risk for heart disease.

You could have an allergic reaction to Helixate FS. Call your healthcare provider right away and stop treatment if you get rash or hives, itching, tightness of the chest or throat, difficulty breathing, light-headed, dizziness, nausea or a decrease in blood pressure.

Your body can make antibodies, called "inhibitors," against Helixate FS, which may stop Helixate FS from working properly. Consult with your healthcare provider to make sure you are carefully monitored with blood tests for the development of inhibitors to factor VIII.

Other common side effects of Helixate FS are local injection-site reactions (pain, swelling, irritation at infusion site) and infections from implanted injection device. Tell your healthcare provider about any side effect that bothers you or does not go away.

Call your healthcare provider right away if bleeding is not controlled after using Helixate FS.

Indications

Helixate FS, Antihemophilic Factor (Recombinant), is medicine used to replace the clotting factor (factor VIII or antihemophilic factor) that is missing in people with hemophilia A.

Helixate FS is used to treat and control bleeding in adults and children with hemophilia A. Your healthcare provider may give you Helixate FS when you have surgery. Helixate FS can reduce the number of bleeding episodes in adults and children when used regularly (prophylaxis), and can reduce the risk of joint damage in children without preexisting joint damage when used regularly.

Helixate FS is not used to treat von Willebrand disease.

Please see the full Prescribing Information for HELIXATE FS, including approved patient labeling.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.