ONPATTRO

Accurate reimbursement and compliance with ONPATTRO® (patisiran) depend on proper billing and coding. Here are several important rules:
Code for HCPCS:
J0222: 0.1 mg injection of patisiran.
Billing Example: Report 300 units of J0222 for a dosage of 30 mg of ONPATTRO.
CPT Administration Codes:
96365: Initial, up to one-hour intravenous infusion for diagnosis, treatment, or prevention.
Usage: Suitable for the first hour of ONPATTRO intravenous infusion.
96366: Intravenous infusion for diagnosis, treatment, or prevention; every hour.
Usage: After the initial hour of infusion, report for each extra hour.

E85.1: Neuropathic heredofamilial amyloidosis is the diagnosis code.
71336-1000-xx: ONPATTRO 10 mg/5 mL single-dose vial is the National Drug Code (NDC).
Billing considerations: Drug Waste Reporting: Report any drug that is thrown away from single-use vials using the JW modifier. In the patient's medical file, note how much was given and how much was thrown away.
Location of Service: ONPATTRO is usually given at a doctor's office that is prepared to handle infusion treatments or an outpatient hospital.
Records: Keep thorough medical records that cover the diagnosis, course of therapy, dosage, administration method, and any medication waste. This paperwork helps with the processing of claims and shows medical necessity.

Other Resources: ONPATTRO Access & Reimbursement: Provides assistance to healthcare practitioners, such as aid with prior authorization, benefits verification, appeals, coding and billing details, and specialty pharmacy options.
Following these recommendations will make it easier to accurately bill and get paid for ONPATTRO treatment. Consult the specific requirements of each payer and keep abreast of any modifications to coding standards.