Lioresal (Baclofen)
Billing
Code: J0476
Description: Baclofen intrathecal trial
Unit: 50 mcg
Payment: $46.921
Pay quarter: Q4 2023
Dosage and Frequency
Calculate drug reimbursement
Total Reimbursement:
$46.92(ASP: $44.27, Margin: $2.66)
Code:
J0476# Units to bill:
1Prior Authorization
Prior auth criteria for Lioresal may include but is not limited to:
Insurance prior auth guidelines:
Billable NDCs
25021-0681-71
BACLOFEN (SAGENT PHARMACEUTICALS INC)
100 MCG
66794-0151-01
GABLOFEN (PIRAMAL CRITICAL CARE)
50 MCG
70121-2496-05
LIORESAL (AMNEAL PHARMACEUTICALS INC)
250 MCG
70257-0562-55
Lioresal (SAOL THERAPEUTICS)
250 MCG
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