Pharmacy Question for the Week of April 2, 2018

Pharmacy Compliance Question of the Week

Question:

What code should be assigned for Prolia?

Answer:

For Prolia injections, assign J0897 (injection, denosumab, 1 mg). In its Targeted Probe and Educate Program guidelines, the Centers for Medicare & Medicaid Services (CMS) state that it is used in patients with osteoporosis at high risk of fracture, females on aromatase therapy for breast cancer, and males on androgen-deprivation therapy. Documentation should include a proof of osteoporosis or cancer treatment, physician order, and administration record.

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