Provenge (Sipuleucel-T)
Billing
Code: Q2043
Description: Sipuleucel-t auto cd54+
Unit: 1 infusion
Payment: $53981.464
Pay quarter: Q1 2023
Dosage and Frequency
Prostate cancer
• One dose IV every 2 weeks for 3 doses
• One dose IV every 2 weeks for 3 doses
Calculate drug reimbursement
Total Reimbursement:
N/A(ASP: N/A, Margin: N/A)
Code:
Q2043# Units to bill:
N/APrior Authorization
Prior auth criteria for Provenge may include but is not limited to:
Insurance prior auth guidelines:
Billable NDCs
30237-8900-06
PROVENGE (DENDREON PHARMACEUTICALS LLC)
0 Per infusion (minimum 50 million cells)
Resources