Drug IndexLumizyme (Alglucosidase Alfa)



Billing

Code: J0221

Description: Lumizyme injection

Unit: 10 MG

Payment: $201.965

Pay quarter: Q4 2024


Covered in Part D: No


Drug Cost

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Total WAC:

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Total Reimbursement:

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(ASP: N/A, Margin: N/A)

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# Units to bill:

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Billable NDCs

58468-0160-01

Lumizyme (Genzyme Corporation)

1 VIAL, SINGLE-USE in 1 CARTON (58468-0160-1) / 10.5 mL in 1 VIAL, SINGLE-USE



Prior Authorization


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