An ASP posting for Q1 2007 for J-Code 1562 for use in clinical, hospital outpatient and physician office settings is expected to be included in the next set of ASP rates that CMS likely will issue in the middle of December. [NOTE: This is the first mention of the physician office setting. You may want to drop a footnote to address the physician office setting since the two sections you have address the pharmacy supplier and the hospital outpatient department.]

All changes to the code set are effective January 1, 2007. The billable unit for Vivaglobin®, Immune Globulin Subcutaneous under HCPCS Level II, J-1562 is equal to 100mg/one billable unit.

When converting patients from IVIG use the following dosing formula:

Begin with IVIG Monthly Dose/Grams,Treatment interval = Weekly IVIG dose/gram
E.g.: 40 grams monthly
Monthly IVIg dose in grams, 4 = weekly dose of Vivaglobin®
Weekly dose, .16 = mls per week. Mls per week x 1.37 = total weekly dose of Vivaglobin®.
Total weekly dose x 4 = monthly Vivaglobin® dosing.

* treatment interval refers to how often patient receives IVIG (i.e.: if patient receives treatment every 3 weeks or every 4 weeks divide by that number.

When billing for Vivaglobin®, it is necessary to convert mls to mgs to obtain total billable units.

Billable unit = 100mg
Total mls of Vivaglobin x 160 mg, 100 mg = total number of billable units.
E.g.: 40 grams,4 weeks = 10 grams/week
10 grams, .16 = 62.50 mls/week
62.50 x 1.37 = 85.63ml
Choose the most appropriate single use vial sizes for Vivaglobin (ie:4 of the 20 mls and 2 of the 3 mls)
86 x 160 = 13,760 mg
13,760, 100 = 137.6 or 138 billable units/week
or: 86 mls x 1.6 = 137.6 = 138 billable units

Vivaglobin® monthly dosing (non IND study)
E.g.: 40 grams/month
Monthly IVIg dose in grams, 4 = weekly dose of Vivaglobin®
Weekly dose, .16 = mls per week.
Total weekly dose x 4= monthly Vivaglobin® dosing.
Weekly dose x 160mg,100= total billable units/week

Billable unit = 100 mg.
Total mls of Vivaglobin® x 160mg,100mg = total number of billable units.
E.g.: 40 grams,4 = 10 grams/week
10 grams, .16 = 62.5mls
Choose the most appropriate single use vial sizes for Vivaglobin® (3 of the 20 ml, + 1 of the 3 ml)
63 mls x 160mg = 10080 mg
10080 mg,100 mg=100.8 or 101 billable units

E.g.: 40 grams,4 = 10 grams/week
10 grams, .16 = 62.5mls
Choose the most appropriate single use vial sizes for Vivaglobin® (3 of the 20 ml, + 1 of the 3 ml)
63 mls x 160mg = 10080 mg
10080 mg,100 mg=100.8 or 101 billable units
or: 63 mls x 1.6 = 100.8 = 101 billable units

Questions concerning appropriate coding for Medicare should be directed to the Medicare third party payer or the Medicare Part B DME Contractor in whose jurisdiction the claim would be filed. For private payers contact the insurance contractor. For Medicaid systems, contact the Medicaid Agency in the state in which the claim is being filed.

For reimbursement assistance regarding ZLB Behring therapies you may also contact the ZLB Behring Reimbursement Answerline: 1-800-676-4266

References:
Department of Health and Human Services, Centers for Medicare and Medicaid Services, 2007 HCPCS Annual Update, www.cms.hhs.gov/MedHCPCSGenInfo.
Region A, DMERC PSC Bulletin, June 2006

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Reimbursement Alert Online December 2006

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