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Lumizyme (alglucosidase alfa)


Billing

Code: J0221

Description: Lumizyme injection

Unit: 10 mg

Payment: $188.444

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Pompe disease

• 20mg/kg IV every 2 weeks

Calculate drug reimbursement


Total Reimbursement:

$31,960.10

(ASP: $30,151.04, Margin: $1,809.06)


Code:

J0221

# Units to bill:

160

Prior Authorization

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





Insurance prior auth guidelines:


Billable NDCs

58468-0160-01

Lumizyme (GENZYME CORPORATION)

50 MG


58468-0160-02

Lumizyme (GENZYME CORPORATION)

500 MG



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