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Coding
and Billing

 

Coding and billing information for Rapivab® (peramivir injection)

Use this information to facilitate coding and billing processes. Some payers will require the National Drug Code (NDC) code for Rapivab.1

 

Support and access for Rapivab

RAPIVAB CUSTOMER SUPPORT CENTER
1-833-964-2956 and rapivab.com

 

  • Current Procedural Terminology (CPT) Codes for Rapivab

    The following CPT codes are for treatments administered via injection to individuals.

    CPT Code 2 Description
    96365 Intravenous (IV) infusion for therapy, prophylaxis, or diagnosis; initial, up to first hour
    96366 IV med therapy−each additional hour
    96374 IV med injection−first med
    96375 IV med injection−second med subsequent injection
    96376 IV med injection−first med subsequent injection
    96360 IV hydration−first hour
    96361 IV hydration−each additional hour

     

    HCPCS Code 3 Description
    J2547 Injection, peramivir, 1 mg
    • Report the administration of Rapivab in addition to the treatment product code
    • Assign the appropriate administration code based on the documentation in the medical record
    • Medicare requires the use of an HCPCS code for the administration of Rapivab. Some payers may also require that an HCPCS code be used to report Rapivab

    Prior authorizations or appeals may not be completed or filed on the HCP's behalf.

  • Revenue codes for Rapivab

    These codes are used to attribute hospital charges to specific cost centers. They may vary by service provided and patient status.

    Revenue Code 4 Description
    0636 Drugs requiring detailed coding required by Medicare to obtain pass-through payment for drugs in the outpatient department
    0250 Pharmacy, general
    0260 Intravenous therapy, general
    0450 Emergency room
    0510 Clinic
    0520 IV hydration–first hour
  • ICD-10-CM codesa for Rapivab

    Refer to these tables when you need the ICD-10-CM codes for Rapivab.

    ICD-10 Code 5 Description
    J10.00 Influenza due to other identified influenza virus with unspecified type of pneumonia
    J10.01 Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia
    J10.08 Influenza due to other identified influenza virus with other specified pneumonia
    J11.00 Influenza due to unidentified influenza virus with unspecified type of pneumonia
    J11.08 Influenza due to unidentified influenza virus with specified pneumonia
    J12.9 Viral pneumonia, unspecified
    J10.1 Influenza due to other identified influenza virus with other respiratory manifestations
    J11.1 Influenza due to unidentified influenza virus with other respiratory manifestations
    J10.2 Influenza due to other identified influenza virus with gastrointestinal manifestations
    J10.81 Influenza due to other identified influenza virus with encephalopathy
    J10.82 Influenza due to other identified influenza virus with myocarditis
    J10.83 Influenza due to other identified influenza virus with otitis
    J10.89 Influenza due to other identified influenza virus with other manifestations
    J11.2 Influenza due to unidentified influenza virus with gastrointestinal manifestations
    J11.81 Influenza due to unidentified influenza virus with encephalopathy
    J11.82 Influenza due to unidentified influenza virus with myocarditis
    J11.83 Influenza due to unidentified influenza virus with otitis media
    J11.89 Influenza due to unidentified influenza virus with other manifestations
    J09.X1 Influenza due to identified novel influenza A virus with pneumonia
    J09.X2 Influenza due to identified novel influenza A virus with other respiratory manifestations
    J09.X3 Influenza due to identified novel influenza A virus with gastrointestinal manifestations
    J09.X9 Influenza due to identified novel influenza A virus with other manifestations

    aThis may not be an all-inclusive list; see payor-specific coverage policies for covered indication.

References: 1. Rapivab [package insert]. Durham, NC: BioCryst Pharmaceuticals, Inc; 2021. 2. Current Procedural Coding Expert; 2021 Chicago IL: Optum360; 2021. 3. Parman C. Hospital regulatory update. Association of Community Cancer Centers website. https://www.accc-cancer.org/oncology_issues/articles/JF16/JF16-Oncology-Coding-Reimbursement-Update.pdf. Accessed March 16, 2021. 4. CMS Manual System: Pub. 100-04 Medicare claims processing. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r167cp.pdf. Published April 30, 2004. Accessed March 16, 2021. 5. Nelson M. ICD-10 cometh. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&cad=rja&uact=8&ved=0ahUKEwih4NKzjLfLAhXLTCYKHc2LAAUQFgg5MAQ&url=https%3A%2F%2Fwww.chestnet.org%2F~%2Fmedia%2Fchesnetorg%2FPublications%2FDocuments%2FCHEST%2520Physician%2FICD10InfluenzaCodes.ashx&usg=AFQjCNH5tCT-_gZ8SmRF_CZi0vB-OvUyFQ&sig2=JQocAaPEHmQ0wQsagrgHLQ&bvm=bv.116573086,d.cWw. Published April 2015. Accessed March 16, 2021.
Important Safety Information  

RAPIVAB® (peramivir injection) Important Safety Information

Indication

RAPIVAB is indicated for the treatment of acute uncomplicated influenza in patients 6 months and older who have been symptomatic for no more than 2 days.

Limitations of Use
  • Efficacy of RAPIVAB is based on clinical trials of naturally occurring influenza in which the predominant influenza infections were influenza A virus; a limited number of subjects infected with influenza B virus were enrolled.

  • Influenza viruses change over time. Emergence of resistance substitutions could decrease drug effectiveness. Other factors (for example, changes in viral virulence) might also diminish clinical benefit of antiviral drugs. Prescribers should consider available information on influenza drug susceptibility patterns and treatment effects when deciding whether to use RAPIVAB.

  • The efficacy of RAPIVAB could not be established in patients with serious influenza requiring hospitalization.

Contraindications

RAPIVAB is contraindicated in patients with known serious hypersensitivity or anaphylaxis to peramivir or any component of the product. Severe allergic reactions have included anaphylaxis, erythema multiforme and Stevens-Johnson Syndrome.

Warnings and Precautions
  • Cases of anaphylaxis and serious skin/hypersensitivity reactions such as Stevens-Johnson syndrome and erythema multiforme have occurred with RAPIVAB. Discontinue RAPIVAB and initiate appropriate treatment if anaphylaxis or serious skin reaction occurs or is suspected.

  • Neuropsychiatric events: Patients with influenza may be at an increased risk of hallucinations, delirium and abnormal behavior early in their illness. Monitor for signs of abnormal behavior.

  • Serious bacterial infections may begin with influenza-like symptoms or may coexist with or occur as complications during the course of influenza. RAPIVAB has not been shown to prevent such complications.

Adverse Reactions

The most common adverse reaction in adults (18 years of age and older) was diarrhea (8% RAPIVAB vs 7% placebo). Lab abnormalities (incidence ≥2%) occurring more commonly with RAPIVAB than placebo were elevated ALT > 2.5 times the upper limit of normal (3% vs 2%), elevated serum glucose >160 mg/dL (5% vs 3%), elevated CPK at least 6 times the upper limit of normal (4% vs 2%), and neutrophils <1.0 x 109/L (8% vs 6%). In a subset of subjects with serious influenza requiring hospitalization treated with RAPIVAB 600 mg as monotherapy (N=101), the following adverse reactions were also reported more frequently with RAPIVAB as compared to placebo: constipation (4% versus 2%), insomnia (3% versus 0%), AST increased (3% versus 2%), and hypertension (2% versus 0%).

The safety profile of RAPIVAB in subjects 6 months to 17 years of age was generally similar to that observed in adults. The only adverse reaction reported in pediatric subjects treated with RAPIVAB (occurring in ≥2% of subjects) and not reported in adults was vomiting (3% versus 9% for oseltamivir). The only clinically significant laboratory abnormality (DAIDS Grade 2) occurring in ≥2% of pediatric subjects treated with RAPIVAB (and not previously reported in adults) was proteinuria by dipstick analysis (3% versus 0% for oseltamivir).

Concurrent Use With Live Attenuated Influenza Vaccine

Antiviral drugs may inhibit viral replication of a live attenuated influenza vaccine (LAIV) and thus may reduce vaccine efficacy. The concurrent use of RAPIVAB with LAIV intranasal has not been evaluated. Avoid use of LAIV within 2 weeks before or 48 hours after administration of RAPIVAB, unless medically indicated.

Please see full prescribing information for RAPIVAB.

You are encouraged to report negative side effects of prescription drugs to the FDA. To report suspected adverse reactions, contact BioCryst Pharmaceuticals at 1-833-633-2279 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

RAPIVAB is a registered trademark of BioCryst Pharmaceuticals, Inc.