EVENITY

A monoclonal antibody called EVENITY® (romosozumab-aqqg) is prescribed to treat osteoporosis in postmenopausal women who are at high risk of fracture. For proper reimbursement and compliance, accurate billing and coding are necessary. A guide to help healthcare providers is provided below:
Details of the product:
Once a month, EVENITY is given as two separate subcutaneous injections of 105 mg each, for a total dose of 210 mg.
Dosage Form: 105 mg/1.17 mL of romosozumab-aqqg in single-use prefilled syringes.

Details of Coding: HCPCS Code: J3111-Injection, 1 mg of romosozumab-aqqg.
Billing Units: For every 1 mg administered, report 1 unit. Bill 210 units for a dosage of 210 mg.
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. Take into account payer-specific policies for billing multiple injections because EVENITY requires two injections each dose.

Codes for ICD-10-CM Diagnosis:
Choose the right code according to the patient's condition. M81.0, age-related osteoporosis without a present pathological fracture, is one example.
M80.0: Current pathological fractures accompanied by age-related osteoporosis.
NDC, or the National Drug Code:
55513-0880-02 is a single-use prefilled syringe with 105 mg/1.17 mL.

Sample entries for the CMS-1500 Claim Form: Box 21: Type the relevant ICD-10-CM diagnosis code (for example, M81.0).
Enter the date of service in Box 24A.
Enter the place of service code (for example, 11 for the office) in box 24B.
Box 24D: For every injection, list the HCPCS code J3111 and, if necessary, the CPT code 96372 on different lines.
Box 24E: Refer to Box 21's diagnosis code.
Box 24G: State how many units were given (210 for a dose of 210 mg, for example).

Other Things to Think About: ·NDC Reporting: Put the NDC in the darkened section of Box 24A, formatted as 11 digits (55513-0880-02, for example).
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.
Policies for Payers: Check with individual payers to confirm precise coding, coverage, and payment policies, as each may have different needs.
Refer to the Amgen EVENITY Billing and Coding Guide for resources and detailed information.