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For more information about AKYNZEO® please see the full US Prescribing Information.
Insurance verification Request Form
Billing and Coding Guides Sample Claim Forms Sample Letters of Medical Necessity
Insurance Verification Request Form
Specialists are available to assist you with supporting patient access to AKYNZEO®. Submit a Verification request form to determine:
- Coverage benefits
- Prior Authorization assistance
- Claim denial and appeal support
AKYNZEO® Capsules and AKYNZEO® Injection Billing and Coding Guides
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For all AKYNZEO formulations, 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
- J code for AKYNZEO Injection, J1454
- J code for AKYNZEO for Injection, J1454
- J code for AKYNZEO Capsules, J8655
- National Drug Codes (NDCs)
- Remember to verify a payer’s coding and coverage policies before administering AKYNZEO®
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
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