ILUMYA

Adults with moderate-to-severe plaque psoriasis who are eligible for systemic therapy or phototherapy can be treated with ILUMYA® (tildrakizumab-asmn), a monoclonal antibody. For proper reimbursement and compliance, accurate billing and coding are necessary. Here are several important rules:
HCPCS Code: J3245: Tildrakizumab-asmn, 1 mg injection.
Billing Example: Since one unit is equivalent to one milligram, bill 100 units for a 100 mg dose of ILUMYA.
The National Drug Code (NDC) for ILUMYA 100 mg single-dose prefilled syringe is 47335-0177-xx.

Administration Codes: A medical practitioner administers ILUMYA subcutaneously. Although the manufacturer does not supply particular CPT® codes for administering ILUMYA, general administration codes could be:
96372: Subcutaneous or intramuscular injection of a therapeutic, preventative, or diagnostic chemical or medication.
96401: Non-hormonal anti-neoplastic chemotherapy administered intramuscularly or subcutaneously.
Note: The particular clinical situation and payer guidelines determine which of these codes should be used. Chemotherapy administration codes may be necessary for certain payers who view ILUMYA administration as complicated.

Diagnosis Codes: The patient's condition should be reflected in the appropriate ICD-10-CM diagnosis codes. A typical code for ILUMYA consists of:
Psoriasis vulgaris (oL40.0).
Additional Billing Considerations: Pre-Authorization: Biologic therapies such as ILUMYA are subject to pre authorization requirements under many insurance plans. Before starting treatment, make sure that all required approvals have been received.
Documentation: Keep thorough medical records that include the diagnosis, treatment plan, dosage, administration route, and specifics of the administration. This paperwork enables efficient claims processing and substantiates medical necessity.
Refer to the manufacturer's ILUMYA Billing and Coding Guide for complete and current information.
Following these recommendations will help ensure that ILUMYA therapy is accurately billed and reimbursed.