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Berinert (C1-inhibitor)


Billing

Code: J0597

Description: C-1 esterase, berinert

Unit: 10 units

Payment: $64.406

Pay quarter: Q4 2023


Medicare history

Dosage and Frequency

Hereditary angioedema (HAE) attacks

• 20IU/kg IV PRN

Calculate drug reimbursement


Total Reimbursement:

$10,304.96

(ASP: $9,721.66, Margin: $583.30)


Code:

J0597

# Units to bill:

160

Prior 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:

Aetna

United Healthcare

Anthem

Cigna


Billable NDCs

63833-0825-02

BERINERT (CSL BEHRING LLC)

500 UNITS



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