HELP FOR BILLING & REIMBURSEMENT

Billing & reimbursement information

Gateway to NUCALA can help provide information about relevant codes and the payer’s coding requirements for NUCALA.

NUCALA J-code

J2182

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    CODING QUICK REFERENCE GUIDE
    Code Type
    		 Code
    		 Description
    HCPCS (Healthcare Common Procedure Coding System)
    		 J2182
    		 Injection, mepolizumab, 1 mg
    NDC (National Drug Code) 0173-0881-01

    00173-0881-01*    		 100 mg/mL mepolizumab in 1-mL single-dose vial, which contains lyophilized powder for subcutaneous injection
    0173-0892-01
    		 100 mg/mL mepolizumab in 1-mL single-dose prefilled autoinjector, which contains solution for subcutaneous injection
    0173-0892-42 100 mg/mL mepolizumab in 1-mL single-dose prefilled syringe, which contains solution for subcutaneous injection
    0173-0904-42 40 mg/0.4 mL mepolizumab in 0.4-mL single-dose, prefilled syringe, which contains solution for subcutaneous injection
    CPT

    		 96372 
    		 Therapeutic, prophylactic, or diagnostic injection (specialty substance or drug); subcutaneous or intramuscular
    96401† Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic

    *Payer requirements regarding use of the 10- or 11-digit NDC vary. Check payer requirements for appropriate reporting of the NDC.
    †The American Medical Association (AMA) has recognized the use of the 96401 administration code for some non-chemotherapy substances, such as certain monoclonal antibody agents and other biologic response modifiers. Since NUCALA is a human monoclonal antibody agent, this CPT code may be applicable. However, criteria for coverage for chemotherapy administration codes for non-chemotherapy drugs do vary by payer. Consult the payer for appropriate documentation in order to support the use of these codes.
    CPT=Current Procedural Terminology; CPT is a registered trademark of the American Medical Association.
    The coding, coverage, reimbursement, and related information presented in this guide is from various third-party sources and is subject to change without notice. GlaxoSmithKline (GSK) cannot guarantee the accuracy or timeliness of these data. It should not be considered a guarantee of success of obtaining third-party insurance payment for any product and should not be relied upon without confirmation. The decision by a Payer to pay for a specific product is based on many factors. It is always the prescriber’s responsibility to determine the appropriate treatment and submit appropriate codes, charges, and modifiers for treatments provided. Providers should contact third-party Payers for specific information on their policies.

Sample claims forms

Your practice or hospital outpatient department may need more information on Centers for Medicare and Medicaid Services (CMS) claims forms 1500 and 1450. Details and examples of each are provided below.

For products and services provided in physician office:

Example of CMS-1500 Claim Form

For products and services provided in hospital outpatient department:

Example of CMS-1450 Claim Form

For questions, visit Gateway to NUCALA or call them at 844-4-NUCALA (844-468-2252) Monday through Friday, 8 AM to 8 PM ET.

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