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Glassia (A1-PI)


Billing

Code: J0257

Description: Glassia injection

Unit: 10 mg

Payment: $5.099

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Alpha-1 Antitrypsin Deficiency

• 60mg/kg IV every 1 week

Calculate drug reimbursement


Total Reimbursement:

$2,594.37

(ASP: $2,447.52, Margin: $146.85)


Code:

J0257

# Units to bill:

480

Prior Authorization

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





Insurance prior auth guidelines:


Billable NDCs

00944-2884-01

GLASSIA (TAKEDA PHARMACEUTICALS AMERICA, INC.)

1 MG



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