reimbursement hotline and web portal

You can find answers to your ORTHOVISC reimbursement questions by visiting the ORTHOVISC^®Line website or contacting our support hotline.

ORTHOVISC^® is eligible for reimbursement by Medicare and most managed care plans. Depending upon reimbursement coverage, ORTHOVISC^® can be obtained by purchasing directly from DePuy Mitek Customer Service at 1-800-382-4682 or writing an ORTHOVISC^® prescription.

Insurance policies and coverage for ORTHOVISC^® vary patient-to-patient and plan-to-plan. It is recommended to check with a specific patient insurance carrier to verify coverage.

ORTHOVISC® offers a Patient Assistance Program through Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF), an independent, non-profit organization. JJPAF provides assistance to patients experiencing financial hardship who have no insurance coverage for their prescription medicines. To learn more about JJPAF, visit, www.jjpaf.org or call 800-652-6227.

ORTHOVISC^®Line web portal

ORTHOVISC^®Line has an online reimbursement support center to provide physicians and their office staff assistance with reimbursement for ORTHOVISC^® High Molecular Weight Hyaluronan.

go to the ORTHOVISC^® support center

how ORTHOVISC^®Line can help

• Provides healthcare professionals with replacement ORTHOVISC^® High Molecular Weight Hyaluronan Injection when a financially and medically qualified patient's claim is denied and unsuccessfully appealed
• Offers patient assistance programs to patients without insurance coverage (financial qualifications required)
• Shares insurance guidelines for private, federal and state programs and plans
• Provides assistance with coding and billing questions
• Verifies patient insurance coverage and prior authorization requirements
• Assists providers on payer-specific claims submission requirements
• Evaluates claim denial reasons and provide assistance with appeals
• Provides published CMS fee schedules and payment process methodologies for ORTHOVISC^® and its associate procedures
• Provides coding information specific to payor requirements and coding guidelines

what ORTHOVISC^®Line cannot do

• Submit a claim
• Guarantee coverage or specific payment level
• Initiate or manage a Prior Authorization
• Complete Medical Necessity documentation on behalf of the prescribing physician
• Submit an appeal
• Represent a provider during appeals with payor
• Waive patient co-pays
• Calculate or discuss provider costs, profit or spread
• Recommend how providers charge for ORTHOVISC® and its associated procedures
• Tell the provider what codes should be used to "maximize" reimbursement

claim codes

Reimbursement rates for ORTHOVISC^®, as well as other competitive hyaluronic acid products, change quarterly and are updated by Centers for Medicare and Medicaid (CMS).

The following codes are used for ORTHOVISC^® Reimbursement for both Medicare and Private Pay Insurance Claims. We encourage you to contact your local Medicare or Private Pay Insurance Carriers to understand the recommended coding for ORTHOVISC®. In addition, ORTHOVISC®Line, 1-866-633-VISC (8472) can serve as a resource to identify codes.

 HCPCS code menu

 diagnosis code menu (ICD-9) Diagnosis codes should be included in Box 21 of the CMS 1500 Form.

 CPT code CPT Codes should be billed on the same claim as ORTHOVISC^® to describe the method of administration. The CPT code should be included in Box 24D of the CMS 1500 claim form. An example CPT Code is:

 modifier menu Several modifiers may be relevant when billing ORTHOVISC^®. Modifiers should be included in Box 24D of the CMS 1500 claim form. Possible modifiers include:

Hospitals use a CMS-1450 or UB-04 claim form. Coding for hospital outpatient is the same as in the physician office, J 7324 - ORTHOVISC, CPT Code 20610, ICD-9 Code 715.16, 715.26, 715.36 and 715.96. Medicare reimbursement for hospital inpatient is based on DRGs.

CMS Part B reimbursement rates—data for Q4, 2010

* New HCPCS J Code -Federal Register/Vol. 72, No. 227, pp 66774 / Nov. 27, 2007 **

www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/
01a19_2010aspfiles.asp#TopOfPage

THE INFORMATION PROVIDED REPRESENTS NO STATEMENT, PROMISE, OR GUARANTEE BY DEPUY MITEK CONCERNING COVERAGE, LEVELS OF REIMBURSEMENT, PAYMENT, OR CHARGE. PLEASE CONSULT YOUR PAYOR ORGANIZATION WITH REGARD TO LOCAL OR ACTUAL COVERAGE AND REIMBURSEMENT POLICIES AND DETERMINATION PROCESSES.

completing an HFCA 1500 claim form

Proper coding and billing are critical steps to ensure prompt claim payment. Codes for ORTHOVISC^® can be found on claims code page. Below are several examples of HCFA 1500 Claim Forms for ORTHOVISC^®. A common error that may lead to claim denial is submitting an incomplete claim form.

ORTHOVISC^® is reimbursed under J 7324. Medicare and Private Pay plans vary in relation to J 7324 for ORTHOVISC^®. We encourage you to contact your local Medicare or Private Pay Insurance Carriers to verify patient specific coverage. In addition, ORTHOVISC^®Line, 1-866-633-VISC (8472) can serve as a resource to identify codes.

example 1 – Initial visit with decision to start ORTHOVISC^®

example 2 – Return visit for 2nd and 3rd injection

example 3 – Follow-up injection with exam for separate condition

example 4 – Bilateral injections

helpful forms to download

You may find these forms helpful for your patients, in addition to information they can learn from calling the ORTHOVISCLine or visiting the support center.

Benefits verification and patient authorization form

Letter of medical necessity form

Appeal template