Lumizyme (alglucosidase alfa)
Billing
Code: J0221
Description: Lumizyme injection
Unit: 10 mg
Payment: $188.444
Pay quarter: Q1 2023
Dosage and Frequency
Pompe disease
• 20mg/kg IV every 2 weeks
• 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:
160Prior 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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