Coding & Billing
TREMFYA® (guselkumab)
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Downloadable Forms
- Business Associate Agreement
Complete a Business Associate Agreement for your practice only once. No individual patient authorizations are required. - Delay & Denial Support Reverification Guide
Use this guide to learn how to confirm your patient's eligibility for Delay & Denial Support/Janssen Link if they have previously been eligible. - Enrollment and Prescription Form
A way to find out if TREMFYA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies.
Enrollment and Prescription Form (en español para Puerto Rico) - Enrollment and Prescription Form (en español para Puerto Rico) A way to find out if TREMFYA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies. En español.
- Enrollment and Prescription Form for EMA A way to find out if TREMFYA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies. (EMA)
- Letter of Appeal
A template to send to patients' insurance companies to help get patients on treatment. - Letter of Exception
A template that you can fill out and submit to a patient’s health insurance provider asking them to cover a medication that is not on formulary. - Letter of Medical Necessity
A template that you can fill out and submit to a patient’s health insurance provider. You may use it to explain why TREMFYA® is medically necessary for your patient. - Letter of Medical Necessity (Reverification)
A template that you can fill out and submit to a patient’s health insurance provider to explain why it is medically necessary for your patient to continue on TREMFYA®. - Patient Affordability Options Discover options that can make TREMFYA® more affordable for your patients.
Patient Affordability Options (en español) - Patient Affordability Options (en español)
Discover options that can make TREMFYA® more affordable for your patients. En español. - Patient Authorization FormIndividual patient form for offices without a Business Associate Agreement.
Patient Authorization Form (en español) - Patient Authorization Form (en español)Individual patient form for offices without a Business Associate Agreement.
- Prescribing Information & Medication Guide (en español)
Product information for TREMFYA®. En español. - Resource GuideA comprehensive summary of support tools for your office to help patients start and stay on treatment.
- Savings Program Additional Co-pay Support Form
- Savings Program Overview Eligible patients using commercial or private insurance can save on out-of-pocket costs for TREMFYA®.
Savings Program Overview (en español) - Savings Program Overview (en español)
Eligible patients using commercial or private insurance can save on out-of-pocket costs for TREMFYA®. En español. - Savings Program Rebate FormA form the patient can submit if the pharmacy isn’t able to process the Janssen CarePath Savings Program card.
Savings Program Rebate Form (en español) - Savings Program Rebate Form (en español)
A form the patient can submit if the pharmacy isn’t able to process the Janssen CarePath Savings Program card. En español. - Verification of Benefits Guide (Medical)
A guide to understanding the Verification of Benefits for your patient’s medical benefits. - Verification of Benefits Guide (Pharmacy)
A guide to understanding the Verification of Benefits for your patient’s pharmacy benefits.
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Coding & Billing
Coding
National Drug Code (NDC)
| 10-digit NDC for Ordering | 11-digit NDC for Billing | Description |
|---|---|---|
| 57894-640-01 | 57894-0640-01 |
100 mg prefilled syringe Single-dose 100 mg prefilled syringe of guselkumab for injection |
| 57894-640-11 | 57894-0640-11 |
100 mg One-Press patient-controlled injector 100 mg single-dose One-Press patient-controlled injector of guselkumab for injection |
HCPCS Codes
| Site of Care | Payer | Dates of Service: January 1, 2018 - December 31, 2018 | Permanent National Code effective January 1, 2019 |
|---|---|---|---|
| Physician Office | Non-Medicare | J3590 - Unclassified biologics | J1628 - Injection, guselkumab, 1 mg |
| Medicare | |||
| HOPD | Non-Medicare | J3590 - Unclassified biologics | J1628 - Injection, guselkumab, 1 mg |
| Medicare | Effective January 1, 2018: C9029 - Injection, guselkumab, 1 mg |
Collected in 10/21 and may change.
This information is not a promise of coverage or payment. It is not intended to give reimbursement advice or increase reimbursement by any payer. The fact that a treatment is assigned a code and payment rate does not promise that it will be covered. Codes are used to describe products, procedures, or services on insurance claims. Payers use these codes with other information to figure out if treatment will be covered, and how much will be paid if covered. Legal requirements and plan information can be updated frequently. Contact the plan for more information about current coverage, reimbursement policies, restrictions, or requirements that may apply.
Please consult your local payer for specific coding policies or call Janssen CarePath for assistance at 877-CarePath (877-227-3728).
Reimbursement Support through Janssen CarePath
Janssen CarePath provides information and assistance regarding coding, coverage, and claims process related to TREMFYA®. In addition, we can also investigate specialty pharmacies that may be available to simplify product procurement and billing for healthcare providers.
If you have questions, please call a Janssen CarePath Care Coordinator at 877-CarePath (877-227-3728), Monday-Friday, 8:00 AM to 8:00 PM ET. Multilingual phone support is available.
Coding
National Drug Code (NDC)
| 10-digit NDC for Ordering | 57894-640-01 |
| 11-digit NDC for Billing | 57894-0640-01 |
| Description |
100 mg prefilled syringe Single-dose 100 mg prefilled syringe of guselkumab for injection |
| 10-digit NDC for Ordering | 57894-640-11 |
| 11-digit NDC for Billing | 57894-0640-11 |
| Description |
100 mg One-Press patient-controlled injector 100 mg single-dose One-Press patient-controlled injector of guselkumab for injection |
HCPCS Codes
| Site of Care | Physician Office |
| Payer | Non-Medicare |
| Medicare | |
| Dates of Service: January 1, 2018 - December 31, 2018 | J3590 - Unclassified biologics |
| Permanent National Code effective January 1, 2019 | J1628 - Injection, guselkumab, 1 mg |
| Site of Care | HOPD |
| Payer | Non-Medicare |
| Dates of Service: January 1, 2018 - December 31, 2018 | J3590 - Unclassified biologics |
| Permanent National Code effective January 1, 2019 | J1628 - Injection, guselkumab, 1 mg |
| Site of Care | HOPD |
| Payer | Medicare |
| Dates of Service: January 1, 2018 - December 31, 2018 | Effective January 1, 2018: C9029 - Injection, guselkumab, 1 mg |
| Permanent National Code effective January 1, 2019 | J1628 - Injection, guselkumab, 1 mg |
Collected in 10/21 and may change.
This information is not a promise of coverage or payment. It is not intended to give reimbursement advice or increase reimbursement by any payer. The fact that a treatment is assigned a code and payment rate does not promise that it will be covered. Codes are used to describe products, procedures, or services on insurance claims. Payers use these codes with other information to figure out if treatment will be covered, and how much will be paid if covered. Legal requirements and plan information can be updated frequently. Contact the plan for more information about current coverage, reimbursement policies, restrictions, or requirements that may apply.
Please consult your local payer for specific coding policies or call Janssen CarePath for assistance at 877-CarePath (877-227-3728).
Reimbursement Support through Janssen CarePath
Janssen CarePath provides information and assistance regarding coding, coverage, and claims process related to TREMFYA®. In addition, we can also investigate specialty pharmacies that may be available to simplify product procurement and billing for healthcare providers.
If you have questions, please call a Janssen CarePath Care Coordinator at 877-CarePath (877-227-3728), Monday-Friday, 8:00 AM to 8:00 PM ET. Multilingual phone support is available.