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For more information about AKYNZEO please see the full Prescribing Information.

Billing and Coding Guides Sample Claim Forms Sample Letters of Medical Necessity

AKYNZEO® Capsules and AKYNZEO® Injection Billing and Coding Guides

  • For either AKYNZEO® formulation, learn about billing and coding including:
    • International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) Codes.
    • Healthcare Common Procedure Coding System (HCPCS) Codes.
    • National Drug Codes (NDCs).
  • Remember to verify a payer’s coding and coverage policies before administering AKYNZEO®.

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Sample Claim Forms for AKYNZEO® Injection

  • Review these annotated sample forms to understand important details you should include about AKYNZEO® when submitting CMS-1450 (UB-04) and CMS-1500 forms.
  • Remember, actual coverage and reimbursement decisions are made by individual payers, and providers have sole responsibility in selecting proper codes and ensuring accurate documentation.

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Sample Letter of Medical Necessity and Appeal

  • Use and adapt these sample letters when submitting information to payers to explain AKYNZEO® medical necessity, or help patients navigate an insurance appeal process.
  • Fill in the blank fields and copy onto your office’s letterhead.

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