Patients & Caregivers

Care OM™

Caphosol^®

Healthcare Professionals

Reimbursement Information

2008 Reimbursement Coding

Reimbursement

Medicaid

Caphosol is reimbursed by Medicaid in most states as a drug or device using the appropriate HCPCS code. HCPCS A9155 is 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. HCPCS code A9155 effective 1/1/08 should be reported per 30 mL dose. As indicated on the box, one box contains 30 doses and should be reported as 30 units when reporting HCPCS A9155.

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 (i.e. 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.

Reimbursement Support

For reimbursement information and support, contact AccessMED at
(888) 837-4397, via fax at (866) 287-3036, or via email at EUSAPharma@accessmed.com.

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.

Important Safety Information: Avoid eating or drinking at least 15 minutes after use. Patients restricted to a low sodium diet should consult their physician before use. Federal law restricts this device to sale by or on the order of a physician or dentist.

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

C-0157-08