Back to drug list

Pulmozyme (dornase alfa)


Billing

Code: J7639

Description: Dornase alfa non-comp unit

Unit: 1 mg

Payment: $50.120

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Cystic Fibrosis (CF)

• 2.5mg once daily

Calculate drug reimbursement


Total Reimbursement:

$132.82

(ASP: $125.30, Margin: $7.52)


Code:

J7639

# Units to bill:

3

Prior Authorization

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





Insurance prior auth guidelines:


Billable NDCs

50242-0100-40

Pulmozyme (GENENTECH, INC.)

75 MG



Resources