AVSOLA

Precise coding and documentation are necessary for AVSOLA® (infliximab-axxq) billing in order to guarantee correct reimbursement. Important things to think about are:
Code for HCPCS:
The definition of AVSOLA is "Injection, infliximab-axxq, biosimilar, (avsola), 10 mg." Use Q5121 for this medication. Ten milligrams of AVSOLA are represented by each billing unit.

The 11-digit National Drug Code (NDC) for AVSOLA should be reported. The NDC for the 100 mg single-dose vial is 55513-0670-01.
Codes for diagnosis:
Choose the right ICD-10-CM codes according to the patient's condition. AVSOLA is recommended for the following conditions: Crohn's disease, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and plaque psoriasis.
Make sure the diagnostic code for ulcerative colitis corresponds with the FDA-approved AVSOLA indications.

Administration and Billing Units: Intravenous infusion is the method used to deliver AVSOLA. By indication, dosage and frequency differ:
3 mg/kg for rheumatoid arthritis at weeks 0, 2, and 6, and then every 8 weeks after that.
5 mg/kg for ankylosing spondylitis at weeks 0, 2, and 6, and then every 6 weeks after that.
5 mg/kg for Crohn's disease and ulcerative colitis at weeks 0, 2, and 6, and then every 8 weeks after that.
5 mg/kg for psoriatic arthritis and plaque psoriasis at weeks 0, 2, and 6, and then every 8 weeks after that.
Based on the patient's weight and recommended dosage, determine the billing units. A patient weighing 70 kg who receives 5 mg/kg, for instance, would need 350 mg, or 35 billing units (350 mg ÷ 10 mg/unit).

Place of Service and Claim Forms: Use the UB-04 (CMS-1450) claim form for hospital outpatient settings.
Use the CMS-1500 claim form for clinics or doctor's offices.
Make sure you include the correct location of service code.
Prior Documentation and Authorization:
·Obtain prior authorization as required by payers. The diagnosis and clinical rationale for AVSOLA therapy, prior treatments and their outcomes, and the treatment plan, which includes the dosage and administration schedule, should all be included in the documentation.

Payer-Specific Policies:

·Review individual payer policies for specific billing requirements. For instance, UnitedHealthcare designates Inflectra and AVSOLA as preferred infliximab products. Coverage for non-preferred products like Remicade or Renflexis may require additional documentation or criteria.

Support Resources:

Amgen® SupportPlus offers assistance with reimbursement and access to AVSOLA. Healthcare providers can contact Amgen SupportPlus at (866) 264-2778, Monday - Friday, 9:00 am - 8:00 pm ET, for guidance on billing, coding, and patient support programs.

·Adhering to these guidelines will facilitate accurate billing and reimbursement for AVSOLA