TROGARZO Billing Coding Guide

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Billing and Coding Guide
PATIENT COVERAGE
1)	Complete a TROGARZO™ Enrollment Form and FAX the patient’s enrollment package
to THERA patient support™ at 1-855-836-3069.
2)	A Patient Care Coordinator will then assess and advise on the patient’s private or government
insurance coverage. The Patient Care Coordinator will also assist in applying any eligible
co-pay assistance.
3)	TROGARZO™ may then be ordered and infused at your office.

HOW TO ORDER
TROGARZO™ Authorized Distributor: Curascript SD
Telephone

1-877-599-7748 (Mon-Fri 8:30AM-7PM ET)

Fax

1-800-862-6208

Website

www.curascriptsd.com

For information on payment, shipping or return policies, please contact Curascript SD directly.

PRODUCT INFORMATION
NDC

Description

62064-122-02

Pack of 2 vials, each containing 200 mg of ibalizumab-uiyk
for intravenous infusion

ICD-10 Code

Description

B20

Human immunodeficiency virus [HIV] disease

CPT Code

Description

96365

IV infusion for therapy, prophylaxis, or diagnosis; initial, up to 1 hour

HCPCS Code

Description

J3490

Unclassified drug

J3590

Unclassified biologic

Please check with payer to verify coding or special billing requirements. Correct coding is the responsibility of the provider submitting a claim for the item or service.

Questions?
Contact us at 1-833-23-THERA (1-833-238-4372),
Mon-Fri 8AM-8PM ET

TROGARZOTM is a trademark of TaiMed Biologics Inc., under license to Theratechnologies Inc.
© 2018 Theratechnologies Inc. All rights reserved.

348-01-11/17
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