August 19, 2011

NYSSMOH MEMBERS:

We have had several members who have recently reported denials with JEVTANA (cabazitaxel) and Medicare.
A few items have been shared to address billing and to help get claims paid as fast as possible. 

CMS 1500 Form (or electronic equivalent)

Coding:  J9999

• Box 19   should include the following:  

                  Name of Drug, NDC#, dosage, and type of administration.                                                    

                  Example:   JEVTANA 60mg IV  NDC 00024582411

• Box 19   – if the Jevtana patient was prescribed oral prednisone, include the following:      patient on p.o. pred

  Hospital CMS 1450 (UB-04) Form (or electronic equivalent)

Coding:  C9276

  Notes Requests:

Medicare has requested further documentation when billing this drug and if you receive such a request, the following are some key issues they are looking for:

• Oral Prednisone must be included in the notes/flow sheet, for each treatment of Jevtana
• The patient must have a treatment history of docetaxel-containing regimen and it must be documented in the chart

If you have any questions please contact
George Coutros
Access & Reimbursement Manager
SANOFI ONCOLOGY
908-751-4862