TYENNE
Reimbursement Tyenne
9/15/20232 min read


Details of the product:
NDC Codes:
o Intravenous (IV) Infusion: NDC 65219-590-04, single-dose vial, 80 mg/4 mL
NDC 65219-591-10, 200 mg/10 mL single-dose vial
NDC 65219-592-20 400 mg/20 mL single-dose vial
NDC 65219-593-01 Subcutaneous (SC) Injection: ₧162 mg/0.9 mL single-dose prefilled syringe
NDC 65219-594-01 single-dose prefilled autoinjector, 162 mg/0.9 mL
Details of the Coding:
HCPCS Code: Q5135: Biosimilar injection of tocilizumab-aazg (TYENNE), 1 mg
Billing Units: Indicate how many milligrams were given. For instance, enter 400 units for a dose of 400 mg.
Modifiers: JA Modifier: Signals the delivery of the drug intravenously.
JB Modifier: Denotes administration by subcutaneous means.
ICD-10-CM Codes for diagnosis: Depending on the patient's condition, choose the right code. Among the examples are:
M05.79: Multiple sites of rheumatoid arthritis without involvement of organs or systems
Other giant cell arteritis (oM31.6)
M08.0: Rheumatoid arthritis in children
CPT Codes: 96413: Intravenous infusion technique, chemotherapy delivery, single or initial substance/drug, up to 1 hour
96372: Subcutaneous or intramuscular injection for therapeutic, preventative, or diagnostic purposes (specify chemical or medication);
An example CMS-1500 Form of Claim Submissions:
Enter the correct ICD-10-CM diagnosis code (e.g., M05.79) 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: Enter HCPCS code Q5135 along with the relevant modifier (JA or JB) and the relevant CPT code (96413 or 96372) on a different line.
Locator 24E: Make use of Locator 21's diagnosis code.
Locator 24G: Show how many units were given (400 for a 400 mg dose, for example).
Extra Points to Remember: ·NDC Reporting: Properly format the National Drug Code (NDC) and place it in the shaded section of Locator 24D.
JW Modifier: If relevant, report any amount of discarded medication using the JW modifier.
Payer Policies: As each payer may have different needs, confirm specific coding, coverage, and payment policies with them.
For more detailed information and resources, consult Fresenius Kabi's TYENNE Billing and Coding Guide.
To guarantee correct billing procedures, it is essential to keep abreast of payer-specific policies and any modifications to coding standards.