Reslizumab has just been assigned a permanent J code (J 2786). However, an average sales price (ASP) has yet to emerge from the marketplace. During the interim, a temporary J code is being used (unclassified biologic). It is expected that an ASP will emerge around Spring 2018, at which time we will provide an updated reimbursement range/number. It should be noted that there is a price differential for the reimbursement received for a temporary J code (typically based on the price of acquisition) versus that for a permanent J code.

Best Practices for Obtaining Reimbursements

Kristin Epland, MSN, FNP-C

Midwest Immunology Clinic and Infusion Center

Additional codes that may be helpful when submitting for reimbursement with the aforementioned therapies include

  • CPT Description
    • Cinqair (reslizumab): J2786
      • J2786-JW Cinqair (reslizumab) waste
    • Gamunex-C (IVIG or SCIG): J1561
    • Privigen (IVIG): 1459
    • IV infusion: 96365
    • A4222 Gammagard (IVIG): J1569
    • Nucala (mepolizumab): J2182
    • Xolair (omalizumab): J2357
    • Infusion supplies; A4222