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Billing and Coding and SAD Article Updates for May/June 2022

Billing and Coding: Denosumab (Prolia ™, Xgeva ™) (A52399)

The article has been corrected to remove the following statement: (calcium 1000 mg daily and at least 400 IU vitamin D daily) from the “Documentation Requirements” for Denosumab (Xgeva®).

Billing and Coding: Psychiatric Partial Hospitalization Programs (A56850)

Article text under National Coverage Provisions, concerning billing by PAs has been updated to comply with regulations allowing PAs to bill Medicare directly.

Self-Administered Drug Exclusion List: Medical Policy Article (A53021 – JK and A53022 – J6)

The article has been updated to add: Ofatumumab (Kesimpta®) (C9399, J3490, J3590) and Tezepelumab-ekko (Tezspire™) (C9399, J3490, J3590) effective for dates of service on or after 7/10/2022.

​​​​​​​Posted 5/31/2022