Coding and Billing
To help you in coding your claim forms for ACTEMRA® (tocilizumab), you may refer to the information below.
Note: The above codes are not all-inclusive; appropriate codes will vary by patient, setting of care and payer. This guide is provided for informational purposes only. Correct coding is the responsibility of the provider submitting a claim for the item or service. Please check with individual payers to verify codes and special billing requirement. Genentech does not make a representation or guarantee concerning coverage or payment for any service or item.
Provider Template Letter
Providers can send this letter to private insurers to inform them of their intention to use ACTEMRA. This may facilitate claims processing during the first few months of the code's availability.
To download the letter to inform private insurers of their intention to use J3262 on ACTEMRA claims, click here.
To download the letter to inform private insurers of their intention to use ACTEMRA on SJIA claims click here.
Coding and Billing Help
If you need immediate assistance with coding and billing questions, help is just one phone call away. You can contact Genentech Rheumatology Access Solutions. We can provide information for ACTEMRA claims processing.
Call Genentech Rheumatology Access Solutions at (866) 681-3261.
This information does not take the place of talking to your healthcare provider about either your medical condition or your treatment with ACTEMRA. Talk with your healthcare provider if you have any questions about your treatment with ACTEMRA.
WHAT IS ACTEMRA?
ACTEMRA is a prescription medicine called an interleukin-6 (IL-6) receptor inhibitor.
- ACTEMRA is used to treat adults with moderately to severely active rheumatoid arthritis (RA) after at least one other medicine called a Tumor Necrosis Factor (TNF) antagonist has been used and did not work well.
- ACTEMRA is used to treat people with active systemic juvenile idiopathic arthritis (SJIA) 2 years of age and older.
IMPORTANT SIDE EFFECT INFORMATION
Some people have serious infections while taking ACTEMRA, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections.
Other serious side effects of ACTEMRA include tears (perforation) of the stomach and intestines, changes in blood test results, (including low neutrophil count, low platelet count, increase in certain liver function tests, and increase in blood cholesterol levels), hepatitis B infection becoming an active infection again, and nervous system problems.
ACTEMRA affects the immune system and may increase your risk of certain cancers. Serious allergic reactions, including death, can happen with ACTEMRA. These reactions may happen with any infusion of ACTEMRA, even if they did not occur with an earlier infusion. Patients must tell their doctor if they have had a previous reaction to ACTEMRA. Patients should not take ACTEMRA if they are allergic to it or any of its ingredients.
Common side effects with ACTEMRA in patients with Rheumatoid Arthritis include upper respiratory tract infections (common cold, sinus infections), headache, and increased blood pressure (hypertension).
Common side effects with ACTEMRA in patients with SJIA include upper respiratory tract infections (common cold, sinus infections), headache, and diarrhea.
Patients must tell their healthcare providers if they plan to become pregnant or are pregnant. It is not known if ACTEMRA will harm an unborn baby. Genentech has a registry for pregnant women who take ACTEMRA. Patients who are pregnant or become pregnant while taking ACTEMRA must contact the registry at 1-877-311-8972 and talk to their healthcare provider.
Patients must call their healthcare provider for medical advice about any side effects. Patients or caregivers may report side effects to the FDA at 1-800-FDA-1088. Patients or caregivers may also report side effects to Genentech at 1-888-835-2555.
For additional important safety information, including Boxed Warning and Medication Guide, please visit www.actemra.com.
ACTEMRA® and its logo are registered trademarks of Chugai Seiyaku Kabushiki Kaisha Corp., a member of the Roche Group.
The Access Solutions logo and the Access Solutions Treatment made possible logo are trademarks of Genentech, Inc.
