CRYSVITA

A monoclonal antibody called CRYSVITA® (burosumab-twza) is prescribed to treat tumor-induced osteomalacia (TIO) and X-linked hypophosphatemia (XLH). For proper reimbursement and compliance, accurate billing and coding are necessary. A guide to help healthcare providers is provided below:
Details of the product:
Administration: A medical professional administers oCRYSVITA by subcutaneous injection.

Dosage forms include single-dose vials that contain 10 mg/mL, 20 mg/mL, or 30 mg/mL.
Details of the Coding:
HCPCS Code: J0584: Burosumab-twza injection, 1 mg.
Units of Billing: Indicate how many milligrams were given. A dose of 30 mg, for instance, ought to be billed as 30 units.

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.
ICD-10-CM Codes for diagnosis:

Choose the right code according to the patient's condition. Familial hypophosphatemia (E83.31) and other adult osteomalacia (M83.8) are two examples.

NDCs, or national drug codes:
Vial: 69794-0102-xx, 10 mg/mL
Vial: 69794-0203-xx, 20 mg/mL
Vial: 69794-0304-xx, 30 mg/mL
CMS-1500 Claim Form Sample Submissions:
Enter the correct ICD-10-CM diagnosis code (for example, E83.31) 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 J0584 on a different line.
Locator 24E: Make use of Locator 21's diagnosis code.
Locator 24G: Show how many units were given (for example, 30 for a dose of 30 mg).

Extra Points to Remember: NDC Reporting: Properly format the National Drug Code (NDC) and place it in the shaded section of Locator 24D.
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 Kyowa Kirin's CRYSVITA Access and Reimbursement Assistance for resources and further information.