CABENUVA

Adults with HIV-1 infection can be treated with CABENUVA®, a long-acting injectable regimen that combines cabotegravir and rilpivirine. Accurate reimbursement and compliance depend on proper billing and coding. A guide to help healthcare providers is provided below:
Details of the product:
Management:
The two intramuscular (IM) injections that make up CABENUVA are one for rilpivirine and one for cabotegravir.
Forms of Dosage:
oInitial Dosing Kit: 600 mg/3 mL of cabotegravir and 900 mg/3 mL of rilpivirine.
The continuation dosage kit includes 600 mg/2 mL of rilpivirine and 400 mg/2 mL of cabotegravir.

Coding Information: HCPCS Code: J0741-Injection, 2 mg/3 mg of cabotegravir with rilpivirine.
Units of Billing: Report the total milligrams of rilpivirine and cabotegravir given, divided by five.
For instance, divide 1500 mg by 5 to get 300 billing units for the beginning dose (600 mg cabotegravir + 900 mg rilpivirine = 1500 mg total).
CPT Code: 96372: Subcutaneous or intramuscular injection for therapeutic, preventative, or diagnostic purposes (name substance or drug).
Billing Units: For each injection, report one unit. Report two units since CABENUVA needs two injections, one for each medicine.

Codes for ICD-10-CM Diagnosis:
B20: HIV illness, or human immunodeficiency virus.
The status of an asymptomatic HIV infection is known as Z21.
NDCs, or national drug codes:
NDC: 49702-0240-15 for the initiation kit and 49702-0253-15 for the continuation kit.Sample Entries on the CMS-1500 Claim Form:
Enter the correct ICD-10-CM diagnosis code (e.g., B20) in locator 21.
Locator 24A: Indicate the service date.
Enter the place of service code (e.g., 11 for office) in locator 24B.
Locator 24D: Provide CPT code 96372 and HCPCS code J0741 on a different line.
Locator 24E: Make use of Locator 21's diagnosis code.
The quantity of units administered should be indicated by locator 24G (for example, 300 units for J0741 and 2 units for 96372).

Other Things to Think About:
NDC Reporting: Properly format the NDC and place it in Locator 24D's shaded region.
Modifiers:
JW Modifier: If appropriate, use this to report any amount of drugs thrown.
JZ Modifier: Shows that no medication has been given to any patients or thrown away.
Payer Policies: As each payer may have different needs, confirm specific coding, coverage, and payment policies with them.
Refer to ViiV Healthcare's CABENUVA Billing and Coding Reference for thorough details and resources.