How do I bill for Vivitrol injection?

If provider office has purchased VIVITROL: Enter the appropriate HCPCS code (J2315) if physician office elected “buy and bill” method for patient and CPT®* code (96372). Payers may also require the NDC number on the claim form.

What is CPT code J2315?

HCPCS code J2315 for Injection, naltrexone, depot form, 1 mg as maintained by CMS falls under Drugs, Administered by Injection .

Is Vivitrol covered by Medicare?

Do Medicare prescription drug plans cover Vivitrol? Yes. 60% of Medicare prescription drug plans cover this drug.

Can I bill an office visit with an injection?

The provider performs and documents a significant, separately identifiable E/M service, which leads to the decision to perform the injection. You may bill both the injection and the E/M service (with modifier 25 appended).

Can CPT code 96372 be billed alone?

96372 CPT code reimbursement is allowed when the injection is performed alone or in conjunction with other procedures/services as allowed by the National Correct Coding Initiative (NCCI) procedure to procedure editing.

Does Ahcccs cover Vivitrol?

Arizona Medicaid covers injectable naltrexone (Vivitrol®) under both FFS and MC plans. Patients must be enrolled in, or have documented proof of, SUD* counseling for Vivitrol coverage. Vivitrol is listed on Arizona’s preferred drug list under both FFS and MC plans. Use of Vivitrol requires prior authorization.

How much does Vivitrol cost per month?

On average, the price of Vivitrol is about $2,099.45 for 1, 380MG Suspension Reconstituted but you can reduce this cost to $1,414.63 by using a SingleCare Vivitrol coupon….Average 12 Month Prices for Vivitrol.

Pharmacy Vivitrol Retail Price Vivitrol SingleCare Price
Walmart $1618.10 $1507.66
Walgreens $2117.16 $1492.86