HEPLISAV-B Access Navigator provides:
Universal vaccination, as recommended by the CDC, can help reduce the rates of hepatitis B infection.1
LMN, letter of medical necessity.
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
Make sure to take these important steps before beginning a formal appeals process:
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.
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.
Request more information
Get infoHEPLISAV-B is indicated for prevention of infection caused by all known subtypes of hepatitis B virus in adults 18 years of age and older.
Do not administer HEPLISAV-B to individuals with a history of severe allergic reaction (eg, 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%).
There are no clinical studies of HEPLISAV-B in pregnant women. Available human data on HEPLISAV-B administered to pregnant women are insufficient to inform vaccine-associated risks in pregnancy.
It is not known whether HEPLISAV-B is excreted in human milk. Data are not available to assess the effects of HEPLISAV-B on the breastfed infant or on milk production/excretion.
Vaccination with HEPLISAV-B may not result in protection of all vaccine recipients.
HEPLISAV-B does not treat liver diseases such as cirrhosis or liver cancer.2
Not all liver cancer is caused by the hepatitis B virus.3
Please see accompanying full Prescribing Information. Or visit www.heplisavbhcp.com
References: 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 2. HEPLISAV-B [package insert]. Emeryville, CA: Dynavax Technologies Corporation; 2023. 3. Hepatitis B Foundation. Risk factors. Accessed May 13, 2024. https://www.hepb.org/research-and-programs/liver/risk-factors-for-liver-cancer
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.
Do not administer HEPLISAV-B to individuals with a history of severe allergic reaction (eg, anaphylaxis) after a previous dose of any hepatitis B vaccine or to any component of HEPLISAV-B, including yeast.