Healthcare Common Procedure Coding System
The following are the drug codes for appropriate billing. Medicare, private payers, and state Medicaid programs require UB-04 (CMS-1450) claim forms (for Hospital Outpatient setting) or CMS-1500 (for Freestanding Infusion Center setting) to report the following codes and amount of product used to facilitate appropriate reimbursement.
‡ Does not include impact of sequestration required by the Budget Control Act of 2011. The effective payment rate for separately covered drugs, including ORBACTIV®, is ASP + 4.3%.
The following are the billing units for ORBACTIV® (oritavancin).
§ Please note: Other payors may require different billing units. Please follow payor guidance.
Accurate reporting of the ORBACTIV® HCPCS code, as well as the quantity administered to each patient, is required for appropriate reimbursement. When completing a UB-04/ CMS 1450 or CMS 1500 form for ORBACTIV®, payers may also require the following information:
Some payers may also require prescribing information, FDA-approval letter, support of medical necessity and a drug purchase invoice.
Content provided for informational purposes only. This information does not guarantee coverage or payment. Codes, coverage, and payment may vary from setting to setting, and from insurer to insurer. The provider submitting a claim is solely responsible for the accuracy of the codes submitted and for compliance with all coverage and reimbursement policies.
Decisions to prescribe ORBACTIV® are by providers working with their patients. The ORBACTIV® Assistance Program provides information about ORBACTIV® and about assistance that may be available to patients who meet certain criteria, including that they are not insured by a federal health care program. More information is available through the ORBACTIV® Assistance Program.
The Medicines Company does not guarantee, and assumes no responsibility for the quality, availability, or scope of the ORBACTIV® Assistance Program services. The Medicines Company reserves the right to rescind, revoke, or amend this offer at any time without notice. Void where prohibited by law.