CONTRAINDICATIONS
NUCALA should not be administered to patients with a history of hypersensitivity to mepolizumab or excipients in the formulation.

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Billing and Coding Support:

Physician office

  • Gateway to NUCALA can provide information about relevant codes for NUCALA, including product codes, procedure codes, NDC numbers, and revenue codes

Hospital outpatient department

  • As with coding for services performed in the physician’s office, coding preferences and requirements in the hospital outpatient setting is dependent on payer type and plan type. Gateway to NUCALA can help identify coding requirements in both settings

Appeals Research Support

If a patient is denied coverage for NUCALA, Gateway to NUCALA is available to research instances of coverage denial and identify steps practices can take to appeal claims. Gateway to NUCALA cannot author appeal letters on behalf of physicians. See sample letter of appeal below.

Sample Forms and Letters

When NUCALA is accessed throughout the patient treatment journey, a practice or hospital outpatient department may encounter the need for information on Centers for Medicare & Medicaid Services (CMS) Claim Forms 1500 and 1450, as well as appeal letters and letters of medical necessity. Details and examples of each are provided below.

Example of CMS 1500 Claim Form

The sample CMS 1500 claim form will illustrate the information generally required of physician offices by payers.

 
 

Example of CMS 1450 Claim Form

The sample CMS 1450 form will illustrate the information generally required of hospital outpatient offices by payers.

 
 

Sample Letter of Appeal

The sample Letter of Appeal will detail the information needed when appealing a denial of coverage for NUCALA.

 
 

Sample Letter of Medical Necessity

The sample Letter of Medical Necessity will explain the medical rationale for choosing NUCALA on a patient-specific basis.

 
 

The decision by a payer to pay for a specific product is based on many factors. It is always the prescriber’s responsibility to determine the appropriate treatment and submit appropriate codes, charges, and modifiers for treatments provided. Providers should contact third-party payers for specific information on their policies.

Get started with enrollment today

Call 844-4-NUCALA (844-468-2252)
Monday through Friday, 8 AM to 8 PM ET

   830268R0 December 2017