HCPCS: J3490 laronidase injection, mg/kg dose, Transitional Pass-Through code (to be assigned)
NDC: 58468-0070-1
Download Statement of Medical Necessity (PDF)
Download A Guide to Billing and Reimbursement for Aldurazyme (PDF)
| Genzyme Corporate | Research | Genzyme Websites | ||||||
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
![]() Mucopolysaccharidosis I (MPS I) is a rare, autosomal recessive genetic disease that affects multiple organ systems and tissues. The disease is caused by a defect in the gene coding for the lysosomal enzyme alpha-L-iduronidase. As a result of this defect, the cells of people with MPS I are either unable to produce the enzyme or produce it in low amounts. Until now, treatment has been palliative and/or high risk.[1] Aldurazyme® (laronidase) is the first enzyme replacement therapy for MPS I. Genzyme has created this website section to provide third-party payors with access to ordering and reimbursement information for Aldurazyme. To bill for Aldurazyme therapy, the provider must use the appropriate codes. The billing procedures may vary according to the site of service or third-party payor guidelines. Below are the codes that are commonly used to bill for Aldurazyme therapy: ICD-9-CM: 277.5 - Mucopolysaccharidoses HCPCS: J3490 laronidase injection, mg/kg dose, Transitional Pass-Through code (to be assigned) NDC: 58468-0070-1 CPT-4 Codes: 90780 and 90781 Letter of Intent
The Letter of Intent (LOI) is a model letter for physicians indicating intent to treat a patient living with MPS I with Aldurazyme. It should be customized to a patient’s specific requirements. The following information is available in Adobe Acrobat Portable Document Format (PDF). You will need the Acrobat Reader to view the document, and a free Acrobat Reader is available here. Statement of Medical Necessity
Download the Statement of Medical Necessity, a form physicians can use to document a patient’s clinical history of MPS I, diagnosis, signs and symptoms. The Statement of Medical Necessity allows physicians to demonstrate that Aldurazyme is medically indicated for the treatment of MPS I in a particular patient. Download Statement of Medical Necessity (PDF) A Guide to Billing and Reimbursement for Aldurazyme
Download A Guide to Billing and Reimbursement for Aldurazyme, a brochure created for providers to help understand coverage, coding and reimbursement. It also describes billing processes and provides answers to frequently asked questions regarding reimbursement for Aldurazyme. Download A Guide to Billing and Reimbursement for Aldurazyme (PDF) Prescribing Information
Download information on the management of MPS I with Aldurazyme®. |
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
ALDURAZYME® (laronidase) is indicated for patients with Hurler and Hurler-Scheie forms of Mucopolysaccharidosis I (MPS I) and for patients with the Scheie form who have moderate to severe symptoms. The risks and benefits of treating mildly affected patients with the Scheie form have not been established.
ALDURAZYME has been shown to improve pulmonary function and walking capacity. ALDURAZYME has not been evaluated for effects on the central nervous system manifestations of the disorder.
Important Safety Information
WARNING
Risk of anaphylaxis. Life-threatening anaphylactic reactions have been observed in some patients during ALDURAZYME infusions. Therefore, appropriate medical support should be readily available when ALDURAZYME is administered. Patients with compromised respiratory function or acute respiratory disease may be at risk of serious acute exacerbation of their respiratory compromise due to infusion reactions, and require additional monitoring.
Life-threatening anaphylactic reactions have been observed in some patients during or up to 3 hours after ALDURAZYME infusions. Reactions have included: respiratory failure, respiratory distress, stridor, tachypnea, bronchospasm, airway obstruction, hypoxia, hypotension, bradycardia, and urticaria. Interventions have included: resuscitation, mechanical ventilatory support, emergency tracheotomy, hospitalization, and treatment with inhaled beta-adrenergic agonists, epinephrine, and intravenous corticosteroids.
In clinical trials and postmarketing safety experience with ALDURAZYME, approximately 1% of patients experienced severe or serious allergic reactions. In patients with MPS I, pre-existing upper airway obstruction may have contributed to the severity of some reactions. Due to the potential for severe allergic reactions, appropriate medical support should be readily available when ALDURAZYME is administered. Because of the potential for recurrent reactions, some patients who experience initial severe reactions may require prolonged observation. The risks and benefits of re-administering ALDURAZYME following an anaphylactic or severe allergic reaction should be considered.
Patients with an acute illness at the time of ALDURAZYME infusion may be at greater risk for infusion-related reactions. Careful consideration should be given to the patient’s clinical status prior to administration of ALDURAZYME.
Patients should receive antipyretics and/or antihistamines prior to infusion. If an infusion reaction occurs, regardless of pretreatment, decreasing the infusion rate, temporarily stopping the infusion, and/or administration of additional antipyretics and/or antihistamines may ameliorate the symptoms.
The most common adverse reactions associated with ALDURAZYME treatment in the clinical studies were upper respiratory tract infection, rash, and injection site reaction The most common adverse reactions requiring intervention were infusion-related reactions involving flushing, fever, headache, and rash.
In postmarketing experience with ALDURAZYME, severe and serious infusion-related reactions have been reported, some of which were life-threatening. The most frequently reported adverse reactions included: chills, vomiting, nausea, arthralgia, diarrhea, tachycardia, abdominal pain, blood pressure increased, and oxygen saturation decreased.
Approximately 91% of patients treated with ALDURAZYME in clinical studies were positive for antibodies to laronidase. The clinical significance of antibodies to ALDURAZYME is not known, including the potential for product neutralization. Adverse events should be reported promptly to Genzyme Medical Information at 800-745-4447, option 2. ALDURAZYME is available by prescription only. To learn more, please see the full prescribing information (PDF) including boxed warning, visit www.ALDURAZYME.com or contact Genzyme at 1-800-745-4447. |
| Terms and Conditions of Use Privacy Policy This site is intended for United States residents only. ©2003-2008 Genzyme Corporation. All rights reserved. | T/MPSI/US/P090/04/08 |
||||||