Back to drug list

Kymriah (tisagenlecleucel)


Billing

Code: Q2042

Description: N/A

Unit: N/A

Payment: Claims for Q2042 must be manually adjudicated

Pay quarter: N/A


Medicare history

Dosage and Frequency

B-cell precursor acute lymphoblastic leukemia (ALL)

• 0.2 to 5.0 x 10^6 CAR-positive viable T cells per kg IV if patient weighs 50kg or below
• 0.1 to 2.5 x 10^8 CAR-positive viable T cells IV if patient weighs above 50kg

Calculate drug reimbursement


Total Reimbursement:

N/A

(ASP: N/A, Margin: N/A)


Code:

Q2042

# Units to bill:

N/A

Prior Authorization

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





Insurance prior auth guidelines:


Billable NDCs


Resources