This section provides information for all of the key areas for REMICADE® (infliximab) reimbursement. Click on any of the links below for more details.
Coverage policies may vary by insurer or even between plans offered by the same insurer. This information is presented for informational purposes only and is not intended to provide reimbursement or legal advice. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. While we have made an effort to be current, the information may not be as current or comprehensive when you view it. Please consult with your counsel or reimbursement specialist for any reimbursement or billing questions.
This chart provides a sampling of various codes that reflect the conversion from ICD-9 to ICD-10.
Payers create resources to address information for health care services. Since information varies by payer, it is important to contact the payer directly or consult its Web site to obtain product-specific coverage.
State Medicare Guidelines
This section provides billing and reimbursement guidelines by state for health care services for Medicare Administrative Contractors (MACs). These guidelines dictate which and under what circumstances products or services are covered and often which billing codes to include on the claim form for those products or services.
Select a state below to view the Part A and Part B guidelines for that state.
This section contains information on state-specific Commercial Payer and Medicare Part D prior authorization.
Exception & Appeals Process Information
Each payer has defined its own process for filing an exception, appeal or grievance. The following EAP Information provides a summary of the process, or links where more information may be obtained. It is important to contact the payer directly or consult its Web site to obtain product-specific information.
This section keeps track of the previous state summary guidelines to help you handle past bills and payment issues.
This section provides an overview of the Medicare program with links to more details on the Medicare Web site. It also describes the Medicare coverage for REMICADE®.
This overview outlines the key points you need to know about reimbursement for REMICADE®. It includes details about coding and coverage for REMICADE® and its administration, important information about documentation of services, and reimbursement support services for REMICADE® for your practice.
This section contains answers to frequently asked questions about reimbursement.