Please note: When billing ALOXI using J2469, the billing unit is 25 mcg.
ALOXI should be billed at 10 units for a 0.25 mg dose.

To view a sample of the Letter of Medical Necessity, simply click the "Sample Letter of Medical Necessity" button below.

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To download a template of the Letter of Medical Necessity that you can customize and submit to Medicare, simply click the "Letter of Medical Necessity" button below.

You will need Adobe Acrobat Reader to view the CMS 1500 Form (for physicians' office).

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