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Information for EMEND® (aprepitant)

The information on this site is intended for healthcare professionals in the United States and is not intended for the general public.

I AM A HEALTHCARE PROFESSIONAL I AM NOT A HEALTHCARE PROFESSIONAL
Merck

Physician office billing

Sample CMS-1500 form
PDF [PDF: 352 KB, 1 Page]
View or download a sample CMS-1500 (08-05) form.

Hospital outpatient billing

Sample UB-04 claim form
PDF [PDF: 352 KB, 1 Page]

Hospital billing of take-home drugs

CMS Manual System, Pub 100-04, Medicare Claims Processing, Transmittal 840
PDF [PDF: 50 KB, 12 Pages]

Patient assistance and reimbursement support (the ACT Program)

Enrollment form
PDF [PDF: 1.03 MB, 3 Pages]

Product Replacement form
PDF [PDF: 336 KB, 2 pages]
(product replacement of EMEND for Injection is only available for dates of service on or before July 31, 2009.)

This information is current as of July 2009. The information provided here is compiled from sources believed to be accurate but Merck makes no representation that it is accurate. As a provider, you are solely responsible for billing third-party payers correctly, and you should determine if any payer-specific guidelines or policies apply. It is the responsibility of each provider to ensure that the billing and coding for all services and products are appropriate and correct. Merck does not guarantee or assure the timeliness or appropriateness of this information for your particular use given the frequent changes in public and private payer billing.

21004427(10)-08/10-EME