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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.

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HCPCS
Billing Description
2016 Medicare Payment
Hospital Outpatient
J2407
Injection, oritavancin, 10 mg
ASP + 6%
Freestanding Infusion Centers and Physician Offices
J2407
Injection, oritavancin, 10 mg
ASP + 6%

‡ 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).

Settings
HCPCS
Billing Description
2016 Medicare Payment
Hospital Outpatient§
J2407
Injection, oritavancin, 10 mg
120 units
(1200 mg = 120 billing units)
Freestanding Infusion Centers and Physician Offices§
J2407
Injection, oritavancin, 10 mg
120 units
(1200 mg = 120 billing units)

§ 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: 

Drug Name
ORBACTIV® (oritavancin) for injection
Route of Administration
By intravenous infusion over 3 hours
Quantity Administered
1200 mg
Dose of Product
1200 mg
NDC

65293-015-01 ORBACTIV® single use 50 mL capacity vial of lyophilized powder containing 400 mg of oritavancin

65293-015-03 Three vials are packaged in a carton to supply for a single 1200 mg dose treatment

Packaging (e.g., single-dose vial)
Three vials packaged in a carton to supply for a single 1200 mg dose treatment

Some payers may also require prescribing information, FDA-approval letter, support of medical necessity and a drug purchase invoice.

For more information regarding Coding and Reimbursement, please click here

DISCLAIMER

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.

Important Safety Information

Contraindications

Use of intravenous unfractionated heparin sodium is contraindicated for 120 hours (5 days) after ORBACTIV® administration because the activated partial thromboplastin time (aPTT) test results are expected to remain falsely elevated for approximately 120 hours (5 days) after ORBACTIV® administration.

ORBACTIV® is contraindicated in patients with known hypersensitivity to ORBACTIV®.

Warnings and Precautions

Coagulation test interference: ORBACTIV® has been shown to artificially prolong aPTT for up to 120 hours, and may prolong PT and INR for up to 12 hours, ACT for up to 24 hours, and D-dimer for up to 72 hours.

Hypersensitivity reactions have been reported with the use of antibacterial agents including ORBACTIV®. Discontinue infusion if signs of acute hypersensitivity occur. Monitor closely patients with known hypersensitivity to glycopeptides.

Infusion-related reactions have been reported. Slow the rate or interrupt infusion if infusion reaction develops.

Clostridium difficile-associated colitis: Evaluate patients if diarrhea occurs.

Concomitant warfarin use: Patients should be monitored for bleeding if concomitantly receiving ORBACTIV® and warfarin.

Osteomyelitis: Institute appropriate alternate antibacterial therapy in patients with confirmed or suspected osteomyelitis.

Prescribing ORBACTIV® in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of development of drug-resistant bacteria.

Adverse Reactions

The most common adverse reactions (≥3%) in patients treated with ORBACTIV® were headache, nausea, vomiting, limb and subcutaneous abscesses, and diarrhea.

See Full Prescribing Information

www.orbactiv.com

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