Common ICD-10 and CPT Codes

For informational purposes only.

ICD-10 Codes¹	M83.8	Other adult osteomalacia
CPT Codes¹	96401	Chemotherapy administration, subcutaneous or intramuscular, nonhormonal antineoplastic
CPT Codes¹	96372	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
Home Health Care Nursing Codes²	99601	Home Infusion Procedures and Services—use this code for up to the first 2 hours of a visit
Home Health Care Nursing Codes²	99602	Home Infusion Procedures and Services—use this code for each additional hour of the visit after the first 2 hours

ICD-10 Codes¹
M83.8	Other adult osteomalacia

CPT Codes²
96401	Chemotherapy administration, subcutaneous or intramuscular, nonhormonal antineoplastic
96372	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

Home Health Care Nursing Codes²
99601	Home Infusion Procedures and Services—use this code for up to the first 2 hours of a visit
99602	Home Infusion Procedures and Services—use this code for each additional hour of the visit after the first 2 hours

ICD-10 Codes¹

M83.8

Other adult osteomalacia

CPT Codes²

96401

Chemotherapy administration, subcutaneous or intramuscular, nonhormonal antineoplastic

96372

Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

Home Health Care
Nursing Codes²

99601

Home Infusion Procedures and Services—use this code for up to the first 2 hours of a visit

99602

Home Infusion Procedures and Services—use this code for each additional hour of the visit after the first 2 hours

Use of the above ICD-10 or CPT Codes does not guarantee that claims related to the treatment of patients with TIO will be reimbursed by a health plan. Please refer to the specific health plan when deciding how to submit a claim for care.

This checklist should be used for educational purposes only. Many health insurers have developed specific policies and criteria for their prior authorization process when it comes to approving TIO. Please refer to the patient’s health plan for specific criteria and documentation requirements. This prior authorization checklist is not intended as a diagnostic tool for TIO and should not be a substitute for a healthcare provider’s clinical expertise.

Common documentation for diagnosis of TIO

The following diagnostic criteria are a representation of common signs and symptoms that may help diagnose TIO and meet some common payer requirements. This is not to suggest that use of CRYSVITA^® (burosumab-twza) will improve these clinical symptoms. Additional documentation may be required.

STEP 1: Biochemical Markers	STEP 2: Clinical Presentation	STEP 3: Imaging	STEP 4: Additional Requirements
Labs showing the patient’s age-appropriate biochemical findings, including fasting serum phosphorus levels below the reference range³	The patient presents with appropriate clinical signs and symptoms³	Functional and/or anatomical imaging has been conducted as part of the evaluation for tumor localization³	The prescribing physician is a TIO-experienced specialist or is consulting with a TIO specialist³

STEP 1:
Biochemical Markers

Labs showing the patient’s age-appropriate biochemical findings, including fasting serum phosphorus levels below the reference range³

STEP 2:
Clinical Presentation

The patient presents with appropriate clinical signs and symptoms³

STEP 3:
Imaging

Functional and/or anatomical imaging has been conducted as part of the evaluation for tumor localization³

STEP 4:
Additional Requirements

The prescribing physician is a TIO-experienced specialist or is consulting with a TIO specialist³

Prior or current disease management interventions

History of inadequate response, contraindication, or intolerance to oral phosphate, active vitamin D, or both³

Documentation including biochemical markers and clinical presentation may be required by the payer for the reauthorization or continuation of CRYSVITA therapy³

Biochemical Markers	Clinical Presentation
Patient achieved and sustained an improvement in serum phosphate levels†	Notes on patient’s improvement in clinical presentation and additional documentation as required by payer

Biochemical Markers

Patient achieved and sustained an improvement in serum phosphate levels†

Clinical Presentation

Notes on patient’s improvement in clinical presentation and additional documentation as required by payer

The information provided is intended for informational purposes and should not be considered a guarantee of treatment access or coverage.

^†For adults and pediatric patients: check monthly, 2 weeks post-dose, for the first 3 months of treatment, and thereafter as appropriate.⁴

Getting your prescribed patients access to CRYSVITA

ACCESS STEPS FOR CRYSVITA

You prescribed CRYSVITA^® (burosumab-twza) for your patients.
Now what?

Enroll your patient today! Kyowa Kirin Cares can help your patient from prescription to treatment with an overview of insurance coverage, financial assistance options, and shipment coordination.

Step 1: Enrollment

Download the enrollment form, fill it out with your patient’s information, sign it, and email it to patientsupport@kyowakirincares.com or fax it to 833-552-3299.

Provide complete and accurate information to reduce additional follow-up and potential treatment delay.

ENROLLMENT FORM

Set expectations with your patient.

Patient consent is needed to proceed with Kyowa Kirin Cares access services and financial assistance options for those who qualify
Let your patient know that they will be assigned a dedicated Case Manager and to expect a call from Kyowa Kirin Cares 833-KK-CARES (833-552-2737)
Use the Patient Next Steps guide to help your patient understand the process and the role they play

DOWNLOAD

Step 2: Authorization

Upon receiving the completed enrollment form, Kyowa Kirin Cares will begin the benefits investigation (BI) process for the patient, then inform you of the results.

For information on prior authorization (PA) or exception requirements, visit https://www.kyowakirincares.com/crysvita-healthcare-providers/#crysvita-resources to learn more and to access medical necessity and appeal letters.

Show description

A flow diagram that shows 2 pathways for the benefits investigation results for the patient. In the first pathway, CRYSVITA^® (burosumab-twza) is covered without prior authorization (PA) and you receive an overview of the benefits investigation. In the second pathway, PA or exception is required for CRYSVITA and a Patient Services Representative will call you to inform you of next steps.

A dedicated Case Manager will call the patient to review insurance coverage. They will inform the patient of the financial assistance options available to them.

Step 3: Procurement

A Field Reimbursement Manager (FRM) will work with you to coordinate a procurement option based on your patient’s BI results. CRYSVITA can be procured by an authorized Specialty Distributor or from a select group of Specialty Pharmacies, and ordering requirements may differ based on the patient’s coverage.

Questions? Ask a representative or call Kyowa Kirin Cares at 833-KK-CARES (833-552-2737) Monday through Friday, 8 AM to 8 PM (ET).

Prior authorization and medical documentation for CRYSVITA

Understanding prior authorization

Documents and other criteria are commonly required by health plans to cover CRYSVITA. A dedicated FRM will contact you with your patient’s plan-specific drug requirements.

Provide all documentation required by the patient’s health plan to prevent delays and denials.

Health plans may require documentation of past and current disease management interventions, such as use of supplement therapy or growth hormone, or orthopedic/dental surgery