Berinert (C1-inhibitor)
Billing
Code: J0597
Description: C-1 esterase, berinert
Unit: 10 units
Payment: $64.406
Pay quarter: Q4 2023
Dosage and Frequency
Hereditary angioedema (HAE) attacks
• 20IU/kg IV PRN
• 20IU/kg IV PRN
Calculate drug reimbursement
Total Reimbursement:
$10,304.96(ASP: $9,721.66, Margin: $583.30)
Code:
J0597# Units to bill:
160Prior Authorization
Prior auth criteria for Berinert may include but is not limited to:
• The patient must have a confirmed diagnosis of HAE.
• The patient’s symptoms must be severe enough to require treatment with C1-INH for rapid relief of symptoms.
• The patient must not have had any previous treatment with C1-INH (human) within the past seven days.
• The patient must not have any known hypersensitivity or anaphylactic reaction to C1-INH or any of Berinert’s components.
• The patient must not have any known malignancies or malignancy-related complications.
• The patient must not be pregnant or breastfeeding.
• The patient must not be taking any medications that interact with Berinert.
• The patient must not have any other serious medical conditions that would interfere with the efficacy of Berinert.
Insurance prior auth guidelines:
Billable NDCs
63833-0825-02
BERINERT (CSL BEHRING LLC)
500 UNITS
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