Back to drug list

Tzield (teplizumab-mzwv)


Billing

Code: J9381

Description: Inj teplizumab mzwv 5 mcg

Unit: 5 mcg

Payment: $36.273

Pay quarter: Q3 2023


Medicare history

Dosage and Frequency

Calculate drug reimbursement


Total Reimbursement:

$13,457.28

(ASP: $12,695.55, Margin: $761.73)


Code:

J9381

# Units to bill:

350

Prior Authorization

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





Insurance prior auth guidelines:


Billable NDCs

73650-0316-01

TZIELD (Provention Bio, Inc.)

2000 MCG


73650-0316-10

TZIELD (Provention Bio, Inc.)

20000 MCG


73650-0316-14

TZIELD (Provention Bio, Inc.)

28000 MCG



Resources