Reimbursement FAQs

Q: What can I do prior to administration of ALOXI^® to verify appropriate reimbursement?

A. Verify that the patient’s benefit policy provides for physician-administered IV injectable drugs and that the benefits apply to the use of ALOXI. Find out exactly what is needed in terms of patient documentation, letter of medical necessity, and product information prior to completion of the claim form. If you still have questions, contact the MGI Pharma Access Program (MAP) at 1-877-644-6270.

Q: What is the most relevant product code for ALOXI?

A. Effective January 1, 2005, the permanent J-Code in the clinic and the hospital outpatient settings is J2469. This code replaces J3490 in the clinic setting and C9210 in the hospital setting; these codes should no longer be used.

Q: How do I bill for the administration of ALOXI?

A. Bill according to the route of administration. Physician offices should complete form CMS 1500 using the appropriate CPT Code for ALOXI. Hospital outpatient setting should complete form CMS 1450 (UB-92), using C8952 for IV push or C8950 for IV infusion.

If you still have questions, contact the MGI Pharma Access Program (MAP) at 1-877-644-6270.

Q: How many units of J2469 do I bill for ALOXI?

A. Always bill 10 units

Q: If necessary, how can I support my claim when billing for Aloxi?

A. It may be necessary to include the following documentation with your claim:

• Letter of medical necessity including current diagnosis, patient history, and rationale for using ALOXI
• Full prescribing information for ALOXI
• FDA approval letter
• Patient information including chart notes, medication flow sheets, pathology reports, relevant scans, and/or x-ray reports

Q: How can I receive information on how to order ALOXI?

A. Contact your specialty oncology wholesaler, or MGI PHARMA sales representative, or visit www.aloxi.com.

Q: What are the more common reasons for claims denial?

A. Claims may be denied for various reasons. Often claims are denied simply due to inaccurate or incomplete information or payor error. These claims may be corrected and resubmitted for payment. Make sure that your claim is clearly marked "resubmission" so that the payor will not consider it a duplicate bill for the same service. In the case of a payor error, a phone call to the payor may result in the claim being reprocessed for payment.