Patients & Caregivers

Oral Mucositis

Caphosol^®

Support Programs

Caphosol Home Delivery Program - NEW!

Healthcare Professionals

Patient Programs

Caphosol Home Delivery Program - NEW!

Reimbursement Information

2009 Reimbursement Coding

Reimbursement

Reimbursement Support

For instructions regarding claims submission and coding, please contact our reimbursement support group (AccessMED):

Telephone: 1-888-837-4397
Email: EUSAPharma@accessmed.com
Toll-free fax: 1-866-287-3036
Hours of operation: 8am to 5pm CST
EUSA Pharma toll Free: 1-800-833-3533

Medicaid

Caphosol^® is reimbursed by Medicaid in some states as a pharmacy benefit or a DME (Durable Medical Equipment) using an appropriate HCPCS code. HCPCS A9155 or state-appropriate code may be required on the claim for payment as well as information required in the narrative field of the claim form. Some states may require an invoice copy and/or prior authorization. California Medicaid (MediCal) requires submission of a TAR.

Commercial Insurers

Most commercial plans have listed Caphosol as a pharmacy product and reimbursement is listed as a tier 2 or tier 3 medication under the pharmacy benefit. Co-payment is based upon the patient's individual plan and tier level. Prior authorization may be required.

Coding

When required to report Caphosol on a claim form to the payer, the provider must select the most appropriate HCPCS code. Codes may vary based upon the payer and provider.

30-Dose Weekly Dispensing Pack

HCPCS code: A9155-900mL
Item number: 08489-8000-01

120-Dose Monthly Dispensing Pack

HCPCS code: A9155-3600mL
Item number: 08489-8000-04

The diagnosis code must be reported in addition to the HCPCS code. If required by the payer, report the Product Code #08489-8000-01.* The Product Code and AWP are listed in Red Book, Medi-Span and First DataBank. If required, the narrative or comment field on the electronic medical claim (EMC) should list the HCPCS code, product, product number and cost (e.g. A9155, Caphosol, 08489-8000-01, cost per 30 doses).

*Please note that the Product Code number conforms to current industry standards and is in a National Drug Code (NDC) format.

Formulary Guide

For a Formulary Guide presenting key formulary information and clinical support available for Caphosol, please click here.

Please see full prescribing information.

Procedure coding should be based upon medical necessity and procedures and supplies provided to the patient. Coding and reimbursement information is provided for educational purposes and does not assure coverage of the specific item or service in a given case. EUSA Pharma makes no guarantee of coverage or reimbursement of fees. To the extent that you submit cost information to Medicaid or any other reimbursement program to support claims for services or items, you are obligated to accurately report the actual price paid for such items, including any subsequent adjustments. Current Procedural Terminology numeric codes, descriptions, and modifiers are trademarks and copyrights of the AMA.

Caphosol Safety Information:

If Caphosol is swallowed accidently, no adverse effects are expected
There are no known interactions with other medications
Reported side effects have been rare and generally mild

Keep out of reach of children. For full prescribing information, please click here.

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