Access and reimbursement

Access and reimbursement

If you have questions about coverage and reimbursement, simply call 1-844-375-4728 to talk to a HEPLISAV-B Access Navigator®, 8 AM to 8 PM EST, Monday through Friday.

Access and Reimbursement Guide Sample LMN

Access Navigators are trained to help with:

  • Billing and coding guidelines
  • Sample claim form information
  • Tips for submitting claims
  • Information on payer coverage and reimbursement
  • Guidance on payer authorization and appeal process
Billing and coding

Billing and coding

Type Code Description
CPT® Drug Code 90739 Hepatitis B vaccine, adult dosage 2-dose schedule, for intramuscular use
CPT Administration Code 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
HCPCS (Administration code for Medicare Part B) G0010 Administration of hepatitis B vaccine
10-Digit NDC Number 43528-003-01
43528-003-05
Prefilled syringe, 1 dose (0.5 mL)
Package of 5 single-dose prefilled syringes
11-Digit NDC Number 43528-0003-01
43528-0003-05
Prefilled syringe, 1 dose (0.5 mL)
Package of 5 single-dose prefilled syringes
ICD-10-CM Z23 Encounter for immunization
MVX Code DVX Dynavax
CVX Code 189 Hepatitis B vaccine (recombinant), adjuvant

CPT is a registered trademark of the American Medical Association (AMA).

Select Type

Code Description
90739 Hepatitis B vaccine, adult dosage 2-dose schedule, for intramuscular use
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
G0010 Administration of hepatitis B vaccine
43528-003-01
43528-003-05
Prefilled syringe, 1 dose (0.5 mL)
Package of 5 single-dose prefilled syringes
43528-0003-01
43528-0003-05
Prefilled syringe, 1 dose (0.5 mL)
Package of 5 single-dose prefilled syringes
Z23 Encounter for immunization
DVX Dynavax
189 Hepatitis B vaccine (recombinant), adjuvant
Submitting claims

Submitting claims

Use this guidance when submitting claims for HEPLISAV-B in the office/noninstitutional setting (CMS-1500 form).

First, complete the top half of the claim form with the patient’s information. Then, fill in the product and diagnosis codes in the sections indicated in the sample form below:

Claim Form
  • Box 17B: Include the NPI number for the ordering/referring physician
  • Box 21: Report the diagnosis codes along with any other diagnoses relevant to the patient’s episode of care on this date of service
  • Box 24A: Include the NDC within the shaded area above the date of service
  • Box 24D: Include the CPT code for HEPLISAV-B: 90739 - Append any necessary modifiers (check for ICD-10 code and diabetes) for proper claim processing
  • Box 24E: Include the ICD-10 code linked to the CPT code to support medical necessity
  • Box 31: Sign if necessary and submit the claim form per the insurance carrier’s/insurer’s instructions
Appealing denied claims

Appealing denied claims

The Affordable Care Act grants the right to ask insurers to reconsider a denied claim or to appeal their decision. Make sure to take these important steps before beginning a formal appeals process:

  • Understand the reason for denial
  • Investigate the appeals guidelines
  • Verify eligibility and reimbursement amounts with the health plan
  • Obtain payer’s phone contact information
  • Guidance on payer authorization and appeal process
appeals checklist

appeals checklist

You may need to include certain forms and documents in an appeals package if an insurer denies treatment to your patient. Each insurer and each patient might need different information.

Please review each denial and the insurer’s guidelines to determine what to include in your patient’s appeals package

  • Letter of Medical Necessity
  • Copy of the patient’s health plan or prescription card (front and back)
  • Letter of Appeal
  • Denial information, including the patient’s denial letter or Explanation of Benefits (EOB) letter
  • Supporting documentation

If the patient’s insurer has not responded within 30 to 60 days of receipt of the appeals package, contact the insurer to check its status

  • Keep a copy of everything you send with the patient’s appeal
  • Keep a log of every phone call you make to the patient’s insurer
  • Write down the date and the name of the person you speak with

REIMBURSEMENT INFORMATION

INDICATION AND IMPORTANT SAFETY INFORMATION
INDICATION

HEPLISAV-B is indicated for prevention of infection caused by all known subtypes of hepatitis B virus in adults 18 years of age and older.

IMPORTANT SAFETY INFORMATION

Do not administer HEPLISAV-B to individuals with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any hepatitis B vaccine or to any component of HEPLISAV-B, including yeast.

Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of HEPLISAV-B.

Immunocompromised persons, including individuals receiving immunosuppressant therapy, may have a diminished immune response to HEPLISAV-B.

Hepatitis B has a long incubation period. HEPLISAV-B may not prevent hepatitis B infection in individuals who have an unrecognized hepatitis B infection at the time of vaccine administration.

The most common patient-reported adverse reactions reported within 7 days of vaccination were injection site pain (23%-39%), fatigue (11%-17%), and headache (8%-17%).

Please see full Prescribing Information.

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INDICATION AND IMPORTANT SAFETY INFORMATION
INDICATION

HEPLISAV-B is indicated for prevention of infection caused by all known subtypes of hepatitis B virus in adults 18 years of age and older.

IMPORTANT SAFETY INFORMATION

Do not administer HEPLISAV-B to individuals with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any hepatitis B vaccine or to any component of HEPLISAV-B, including yeast.

Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of HEPLISAV-B.

Immunocompromised persons, including individuals receiving immunosuppressant therapy, may have a diminished immune response to HEPLISAV-B.

Hepatitis B has a long incubation period. HEPLISAV-B may not prevent hepatitis B infection in individuals who have an unrecognized hepatitis B infection at the time of vaccine administration.

The most common patient-reported adverse reactions reported within 7 days of vaccination were injection site pain (23%-39%), fatigue (11%-17%), and headache (8%-17%).

Please see full Prescribing Information.