Keep the following records for a seamless billing and reimbursement process:
- Pretreatment information sheet (similar to presurgery sheet)
- Informed consent for treatment
- Number, location, and grade of lesions
- Medical necessity for treatment
- Plan of care
- Appropriate ICD-10 code
- Appropriate CPT® code
- Qualified HCP involvement
- Post-care instructions
J7308 is a code exclusive to LEVULAN® KERASTICK® and should be reported for each unit utilized.
- It is against the law to bill another drug or variation of concentration under this code, including compounded formulas
- Pursuant to the Prescription Drug and Marketing Act of 1987 (“PDMA”), prescription drug samples provided to a physician from a pharmaceutical company may never be billed to patients for any reason or at any time. Violation of the PDMA may result in a penalty, such as monetary fines or incarceration
- Reimbursement is dependent upon the payer's payment policy and physician contracted rates
- Medicare physician office payment:
- Basis of payment is Average Sales Price (ASP) plus 6%
- ASP is updated quarterly by the Centers for Medicare & Medicaid Services (CMS)
See the annual CPT®
See the LEVULAN KERASTICK
J-Code flashcard containing the
CMS-1500 sample claim form
There are different CPT® codes associated with PDT treatment.*
These codes differ based on how and by whom the treatment is applied. The provider is required to report the most appropriate diagnosis code based upon the patient’s condition and reason for treatment. LEVULAN KERASTICK is not intended for application by patients or unqualified staff.
For more information on CPT® codes, visit the CMS website’s Physician Fee Schedule Search.
- * The provider must report the most appropriate CPT® code. Regardless of the CPT® code reported, the first stage (application) must always be performed by a qualified healthcare professional.
- CPT® 5-digit numeric codes, descriptions, and numeric modifiers are exclusive copyrights of AMA. All rights reserved.
Frequently Used Forms & Resources
Download the following reimbursement resources and tools for more information on filing claims.
COVERAGE & CODING
Browse coverage and coding guidelines for photodynamic therapy provided by Sun Pharma.Download now
Discover sample letters to amend your contracted rate, request a prior authorization for a patient or plan, appeal a denied claim, and more.Download now
PAYER RESEARCH WORKSHEET
Fill out the form to submit a request for information about the billing status of LEVULAN KERASTICK + BLU-U® for a specific provider.Download now
PROVIDER CLAIM APPEAL FORM
If an insurance company denies coverage, use this form to appeal the claim.Download now
Need additional support?
Enroll into our Pinnacle support program.
The Pinnacle Health Group is partnered with Sun Pharma to provide precertification, coding and reimbursement support for LEVULAN KERASTICK + BLU-U® patients.
Once enrolled, Pinnacle can:
- Perform verification of coverage and benefits for your LEVULAN KERASTICK + BLU-U patients. (This is recommended for all photodynamic therapy (PDT) patients with the exception of Medicare Fee-for-Service Plans.)
- Initiate the prior authorization and predetermination
Already enrolled and need a precertification or prior authorization?
Watch now: billing and coding support
Explore a guided video about LEVULAN KERASTICK access topics.
Attend our peer-to-peer reimbursement support programs