Dupixent J Code :Understanding the J Code for Dupixent

As a patient, medical professional, or caregiver, understanding the Dupixent J Code is essential. Dupixent is a prescription medication used to treat certain types of moderate-to-severe eczema (atopic dermatitis), asthma, and chronic rhinosinusitis with nasal polyposis. It contains the active ingredient dupilumab, which works by blocking specific proteins in the body that contribute to inflammation.

Dupixent is usually given as an injection under the skin every two weeks. It is important to follow your doctor’s instructions for use and to keep all scheduled appointments for the injections.

 The J Code for Dupixent is a code that is used to identify and bill for the medication. In this article, we will provide you with comprehensive information on the Dupixent J Code and how it works.

What is a J Code?

J-Codes belong to a set of procedure codes called Healthcare Common Procedure Coding System (HCPCS) Level II. These codes are utilized by Medicare and other managed care organizations to classify injectable drugs that are typically not self-administered, chemotherapy drugs, and certain orally administered drugs.

Hospitals and medical facilities often use J-codes to document non-oral medications administered to patients, such as inhalation solutions, immunosuppressive drugs, and chemotherapy. These codes are typically used alongside other procedure-based codes, known as CPT codes, which are utilized by physicians. Proper J-coding is especially important when billing for trigger point injections, as medical billers must ensure accurate reporting of the injected drug in the trigger point. As such, meticulous attention to detail is crucial when using J-codes in medical billing.

What is Dupixent?

Dupixent is a medication that is used to treat a variety of conditions, including eczema and asthma. It is a biologic drug that is administered by injection. Dupixent is designed to target specific molecules in the immune system that are involved in causing inflammation. By targeting these molecules, Dupixent can help reduce the severity of symptoms and improve quality of life for patients.

As with any medication, Dupixent can have side effects. Some common side effects include injection site reactions, eye and eyelid inflammation, and cold sores. Serious side effects are rare but can include allergic reactions and an increased risk of infections. Be sure to discuss any concerns or questions with your doctor before starting Dupixent.

What is the Dupixent J Code?

There is a big confusion among billers. Many of them ask to use code J3490 but this code is for (other unclassified drugs) while J3590 is the correct code for (unclassified biological drugs).

Though, every unclassified code should be billed with a fee amount higher than the cost. But there should be an information billed in HCFA (CMS-1500) Form’s box-19.

Here is the way to write the formula;

For Example:

Dupixent 100 MG Given, Acquisition fee=$2000

For Medicare, Medicaid and their Advantage & Managed care Plans, the Dupixent J Code is J3590. This code is used to bill for the drug when it is administered in a doctor’s office or clinic. The J3590 code is an unclassified drug code, which means that it is used for drugs that do not have a specific HCPCS code assigned to them.

For BCBS and other commercial payers C9399 is reimbursable, but still it’s based on payer’s reimbursement policy. Treatment cycle covered for this drug is twice a week so if it’s a medical necessity then there will be no need of prior authorization in commercial payers but in case of more than that. Prior Authorization is must.

Read the policy below:

How does the Dupixent J Code work?

The Dupixent J Code is used to bill for the medication when it is administered in a doctor’s office or clinic. The code is used to identify the drug and the quantity that was administered. The J3590 code is an unclassified biological drug code, which means that the price for the drug is set by the individual healthcare provider or insurance company.

How to bill for Dupixent using the J Code?

Medicare says:

“Hospitals should report charges for all drugs, biologicals, and radiopharmaceuticals, regardless of whether the items are paid separately or packaged, using the correct HCPCS codes for the items used.”

When billing for Dupixent using the J Code, the healthcare provider will need to submit a claim to the insurance company or Medicare. The claim should include the following information:

Patient information, including name, date of birth, and insurance information

The date the drug was administered

The HCPCS code used to identify the drug (J3590 for Dupixent)

The quantity of the drug that was administered

The National Drug Code (NDC) for Dupixent (NDC 0088-2900-01)

You can refer to below image for other NDC Codes according to Sanofi-aventis U.S Llc drug Vials.

It is essential to ensure that all information is accurate and up to date when submitting the claim. Any errors or inaccuracies can result in delayed or denied payment for the drug.

What is the diagnosis of Dupixent?

The covered diagnosis codes for Dupixent will depend on the specific medical condition being treated. Dupixent is approved for use in treating moderate-to-severe eczema (atopic dermatitis), asthma, and chronic rhinosinusitis with nasal polyps.

If you are seeking coverage for Dupixent, it is important to check with your healthcare provider and insurance company to determine the specific diagnosis codes that are covered under your plan. They can help you navigate the coverage process and provide information on any potential out-of-pocket costs associated with the medication.

How to get coverage for Dupixent?

Dupixent is a costly drug, and many insurance companies require prior authorization before covering the medication. To get coverage for Dupixent, patients will need to work with their healthcare provider to complete the necessary paperwork and submit it to their insurance company. The insurance company will review the request and determine whether the medication is medically necessary.

In some cases, insurance companies may deny coverage for Dupixent. Patients can appeal the decision by providing additional medical documentation and working with their healthcare provider to demonstrate the need for the medication.

What is Dupixent drug price?

The price of Dupixent (dupilumab) can vary depending on several factors, including the country where it is being purchased, the dosage prescribed, and the duration of treatment. In the United States, the list price for Dupixent ranges from approximately $3,000 to $6,000 per monthly supply, depending on the dosage and indication. However, the actual price paid by patients may be lower, as discounts and insurance coverage may apply. It is important to consult with your healthcare provider and insurance company for more specific pricing information related to Dupixent.

Conclusion

In conclusion, the Dupixent J Code is an essential code that is used to identify and bill for the medication when it is administered in a doctor’s office or clinic. The J3490 code is an unclassified drug code, which means that it is used for drugs that do not have a specific HCPCS code assigned