AMVUTTRA

Use HCPCS code J0225 for AMVUTTRA, defined as "Injection, vutrisiran, 1 mg." Each billing unit corresponds to 1 mg of vutrisiran.

Report the 11-digit NDC for AMVUTTRA. The 25 mg/0.5 mL single-dose prefilled syringe has an NDC of 71336-1003-01.

For hereditary transthyretin-mediated amyloidosis with polyneuropathy, use ICD-10-CM code E85.1.

Services provided in a physician's office are billed using the CMS-1500 claim form. Ensure the correct place of service code is included.

For Medicare claims, apply the JW modifier to indicate the amount of drug discarded and the JZ modifier when no drug is discarded from single-dose vials, effective for dates of service on or after July 1, 2023. Verify specific payer policies regarding these modifiers.

Obtain prior authorization as required by payers. Documentation should include:

Confirmation of hereditary transthyretin-mediated amyloidosis diagnosis.

Clinical assessments demonstrating polyneuropathy.

Baseline evaluations such as polyneuropathy disability (PND) score, Familial Amyloid Polyneuropathy (FAP) stage, or Neuropathy Impairment Score (NIS).

AMVUTTRA is administered as a 25 mg subcutaneous injection once every three months by a healthcare professional.

Review individual payer policies for specific billing requirements, as they may vary. For instance, UnitedHealthcare has specific criteria for RNA-targeted therapies like AMVUTTRA.

Adhering to these guidelines will facilitate accurate billing and reimbursement for AMVUTTRA.