We’re HERE TO HELP WITH YOUR COVERAGE AND REIMBURSEMENT QUESTIONS

 

Access and reimbursement

Questions about coverage and reimbursement?
Contact HEPLISAV-B Access Navigator®
1-844-375-4728
Monday-Friday 8 AM to 8 PM EST

HEPLISAV-B Access Navigator provides:

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

CDC-recommended vaccines are eligible for first-dollar coverage1,*

Universal vaccination, as recommended by the CDC, can help reduce the rates of hepatitis B infection.1

LMN, letter of medical necessity.

 

Billing and coding

HEPLISAV-B billing and coding types, codes, and descriptions[1-3] HEPLISAV-B billing and coding types, codes, and descriptions[1-3]
 

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:

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

Sample form and guidance for submitting claims
 

Appealing 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
  • Obtain guidance on payer authorization and appeals process
Sample appeals letter

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

Request more information

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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.

Reference: 1. Hughes R IV, Maxim R, Fix A. Vague vaccine recommendations may be leading to lack of provider clarity, confusion over coverage. Health Affairs Blog. May 7, 2019. Accessed April 14, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20190506.172246

See the CDC recommendation

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.