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Aralast NP (A1-PI)


Billing

Code: J0256

Description: Alpha 1 proteinase inhibitor

Unit: 10 mg

Payment: $4.592

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Alpha-1 Antitrypsin Deficiency

• 60mg/kg IV every 1 week

Calculate drug reimbursement


Total Reimbursement:

$2,336.41

(ASP: $2,204.16, Margin: $132.25)


Code:

J0256

# Units to bill:

480

Prior Authorization

Prior auth criteria for Aralast NP may include but is not limited to:





Insurance prior auth guidelines:


Billable NDCs

00053-7201-02

Zemaira (CSL BEHRING LLC)

1 MG


00944-2814-01

Aralast NP (TAKEDA PHARMACEUTICALS AMERICA, INC.)

1 MG


00944-2815-01

Aralast NP (TAKEDA PHARMACEUTICALS AMERICA, INC.)

1 MG


13533-0703-10

Prolastin-C (GRIFOLS USA, LLC)

1 MG


13533-0705-01

Prolastin-C (GRIFOLS USA, LLC)

1 MG



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