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Cinryze (C1-inhibitor)


Billing

Code: J0598

Description: C-1 esterase, cinryze

Unit: 10 units

Payment: $60.725

Pay quarter: Q4 2023


Medicare history

Dosage and Frequency

Hereditary Angioedema (HAE)

• 1000IU IV every 3-4 days if patient's age is 12 years or older
• 500IU IV every 3-4 days if patient's age is 6-11 years

Calculate drug reimbursement


Total Reimbursement:

$6,072.50

(ASP: $5,728.77, Margin: $343.73)


Code:

J0598

# Units to bill:

100

Prior Authorization

Prior auth criteria for Cinryze may include but is not limited to:


• The patient must have a confirmed diagnosis of HAE based on current clinical evaluation and laboratory testing.
• The patient must have a history of at least two episodes of HAE in the past 6 months.
• The patient must not have had any serious adverse reactions to Cinryze in the past.
• The patient must not have any contraindications to Cinryze therapy.
• The patient must not be pregnant, nursing, or planning to become pregnant.
• The patient must be under the supervision of a physician experienced in the diagnosis and management of HAE.


Insurance prior auth guidelines:

United Healthcare

Aetna

Anthem

Cigna


Billable NDCs

42227-0081-05

Cinryze (TAKEDA PHARMACEUTICAL AMERICA, INC.)

500 UNITS


42227-0083-01

Cinryze (TAKEDA PHARMACEUTICAL AMERICA, INC.)

500 UNITS



Resources

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