Effective for dates of service on or after April 1, the Healthcare Common Procedure Coding System (HCPCS) code J0491 is valid for billing injections of 1 mg anifrolumab-fnia or “Inj anifrolumab-fnia 1mg” for short.
For coverage determination and billing inquiries, providers are encouraged to contact their Medicare Administrative Contractor (MAC) and all third-party payers to confirm code adoption and any prior authorization required to administer the treatment. Additionally, it is important to document in the patient’s medical record the patient assessment and any indications appropriate for the drug therapy, as well as to include the correct procedure code and any required modifiers on the claim form.