LEQVIO

Adults with primary hyperlipidemia, particularly heterozygous familial hypercholesterolemia (HeFH), can benefit from LEQVIO® (inclisiran), a small interfering RNA (siRNA) medication that lowers low-density lipoprotein cholesterol (LDL-C) levels. Accurate reimbursement and compliance depend on proper billing and coding. The main rules are as follows:
HCPC Code: J1306: 1 mg injection of inclisiran.
Example of Billing: Since each unit is equivalent to 1 mg, bill 284 units for a 284 mg dose of LEQVIO.
National Drug Code (NDC): 00078-1000-60: LEQVIO prefilled syringe, single-dose, 284 mg/1.5 mL (189 mg/mL).

Hospital Outpatient Department Administration Revenue Codes:
0636: Substances that need thorough coding.
General pharmacy (0250).
0500: Outpatient general services.
0510: Services for the general clinic.
Codes for diagnosis:
The patient's condition should be reflected in the appropriate ICD-10-CM diagnosis codes. The following codes are frequently linked to LEQVIO therapy: E75.5: Other lipid storage diseases.
E78.00: Unspecified pure hypercholesterolemia.
E78.01: Hypercholesterolemia in the family.
E78.2: Hyperlipidemia mixed.
Other hyperlipidemia (E78.49).
E78.5: Unspecified hyperlipidemia.

Other Things to Think About When Billing: Modifiers Add the proper modification for administering LEQVIO in a clinical research setting:
oQ0: Clinical investigational services rendered inside a clinical research study that has been authorized.
oQ1: Standard clinical services rendered in a clinical research study that has been authorized.
Field 19 of the CMS-1500 claim form or Loop 2300 REF02 (REF01=P4) for electronic claims are the appropriate places to report these modifiers.

Registry Reporting: In Field 19 of the CMS-1500 claim form or, in the case of electronic claims, in Loop 2300 REF02 (REF01=P4), providers are required to disclose the registry trial number, which can be an eight-digit code such as "99999999" or a specific NCT number.
Keep thorough medical records that include the diagnosis, treatment plan, dosage, administration route, and any registry information. This paperwork helps with the processing of claims and shows medical necessity.
The buy-and-bill process, which entails purchasing, administering, invoicing, and managing reimbursement, must be followed by clinicians that buy LEQVIO and administer it in-office.