This billing guide has been prepared by Merck & Co., Inc., to help answer billing and reimbursement questions that may arise when you are prescribing EMEND or EMEND for Injection.
Inside you will find details about Medicare coverage of EMEND for appropriate patients,1 as well as sample billing forms for both outpatient clinics and office-based physicians and pharmacies. To help ensure that all eligible patients may receive EMEND, an explanation of services provided by the ACT program—Accessing Coverage Today for EMEND—is also provided.
Your Merck representative may have information about local Medicare and managed care organization coverage of EMEND.
> Download a template for a Prior Authorization Letter for EMEND
> Download a template for an Appeal Letter for EMEND for Injection
Finally, an overview of antiemetic guidelines is included for your information and convenience.
EMEND, in combination with other antiemetic agents, is indicated for prevention of:
- Acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy, including high-dose cisplatin.
- Nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy.
This information is current as of May 2008. Confirm all coding and billing information with individual third-party payers because policies may differ. The codes provided in this resource serve only as a guide, and their use does not guarantee payment. It is the responsibility of each provider to ensure that the billing and coding for all services and products are appropriate and correct.
Reference: 1. Centers for Medicare & Medicaid Services. Decision memo for aprepitant for chemotherapy-induced emesis (CAG-00248N). cms.hhs.gov/mcd/viewdecisionmemo.asp?id=133. Published April 4, 2005. Updated
May 30, 2008. Accessed July 16, 2008.
For information about Merck products or services, please call 866-448-7590. The Merck National Service Center will be pleased to assist you Monday through Friday from 8 AM to 7 PM ET.
