Patient Assistance Services Overview
The CUBICIN Patient Assistance & Reimbursement Hotline is available to medical billing staff, healthcare providers, and anyone else with questions about insurance coverage, coding, and reimbursement for CUBICIN. Contact Cubist Pharmaceuticals customer service at:
1-866-RX-DAPTO (1-866-793-2786)
Call this national toll-free number between 8:00 AM and 8:00 PM Eastern Time, Monday through Friday. With just one call, you will be connected with an associate who will answer your questions.
The representatives who staff the CUBICIN Patient Assistance & Reimbursement Hotline are available five days a week, 12 hours a day. They are happy to answer questions you may have at other times, too. Simply leave a message that includes your name, nature of call, and a number at which you can be reached, and an associate will return your call within one business day.
Outpatient Reimbursement
Medicare, many state Medicaid programs, and most private insurers provide reimbursement to hospitals for drugs when administered in the outpatient setting. Often the drug is reimbursed separately from the administration service.
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Important Information Regarding CUBICIN and Medicare Payment in the Hospital Outpatient Setting
Medicare finances hospital outpatient care via a prospective payment system based on Ambulatory Payment Classification (APCs). Under OPPS, services provided to Medicare patients in the hospital outpatient setting correspond to these prospectively set payment groups. Many drugs administered in the hospital outpatient setting are considered "packaged" into APCs, and therefore are not paid separately. However, drugs that exceed a cost threshold of $55 per day are eligible to be paid for separately and assigned a drug-specific APC. As of January 1, 2007, CUBICIN has been assigned APC 9124, daptomycin injection, and will be paid at a rate equal to ASP plus 6 percent.
J- and C-Codes
Coding systems provide a uniform language for describing medical, surgical, and diagnostic services, patient conditions, and certain drugs and supplies. Correct coding of all components of a service is necessary to obtain appropriate reimbursement.
HCPCS codes are 5-digit alphanumeric codes consisting of 1 letter and 4 numbers that reflect a supply or service provided by the physician in the office or by staff in the hospital outpatient setting. J-codes are assigned by generic name to drugs administered via methods other than oral. The permanent J-code for CUBICIN is J0878, injection, daptomycin, 1 mg.
It is important to note that J0878 describes 1 mg of daptomycin for injection. Providers billing for CUBICIN should specify the number of units infused in box 24G "days" or "units" of the CMS-1500 claim form, or field 46 "service units" of the UB-92 (UB-04 effective May 23, 2007) claim form (whichever is appropriate given the payer and applicable setting of care). For example, a physician office wishing to bill for 500 mg of CUBICIN vial would list J0878 on the CMS-1500 and indicate "500" in the days or units field.
CMS-1500 claims for freestanding IV infusion center/physician office services (and physicians' professional services in other settings of care) and UB-92 facility claims for hospital outpatient services must contain appropriate CPT codes (also known as Level 1 HCPCS codes).
It is the responsibility of the healthcare provider to ensure the accuracy and appropriateness of any information submitted for CUBICIN reimbursement.
Questions About Billing and Reimbursement?
The
Billing Guide for CUBICIN can help answer your billing and reimbursement questions, from coding to applying for establishing medical necessity to appealing denied claims.
If you have additional questions, please call toll free 1-866-RXDAPTO (1-866-793-2786) and select option #2.
It is the responsibility of the healthcare provider to ensure the accuracy and appropriateness of any information submitted for CUBICIN reimbursement.
The above information is accurate as of January 1, 2007, and is subject to change without notice.
