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Provenge (Sipuleucel-T)


Billing

Code: Q2043

Description: Sipuleucel-t auto cd54+

Unit: 1 infusion

Payment: $53981.464

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Prostate cancer

• 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/A

Prior 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)



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