Level II HCPCS Codes for billing Probuphine® HCPCS Code Description Use J0570 Buprenorphine implant, 74.2 mg Physician office and Outpatient Ambulatory Facilities Probuphine has been assigned a specific J-Code for Probuphine (J0570) beginning January 1, 2017.
Full Answer
What should I do if my Probuphine implants come out?
reimbursement for the procedure PR0035-007 Probuphine has been assigned a specific J-Code for Probuphine (J0570) beginning January 1, 2017. This for the drug code only. The Medicare Allowable is per implant (descriptor 74.2mg) and reimbursed at $1,311.75 which is ASP + 6%.
What are the risks of removing Probuphine implants?
PROBUPHINE. Do not take any medicine during treatment with PROBUPHINE until you have talked with your healthcare provider. Your healthcare provider will tell you if it is safe to take other medicines during treatment with PROBUPHINE. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist each time you get
What are acceptable doses of transmucosal buprenorphine?
Probuphine is used to treat certain adults who are addicted to (dependent on) opioid drugs (either prescription or illegal). Probuphine is a part of a complete treatment program that also includes counseling and behavioral therapy. Probuphine implants contain the opioid buprenorphine, which may cause physical dependence.
Is naltrexone covered by medical?
This monthly Naltrexone injection reduces alcohol and opiate cravings and is covered by Medi-Cal.
What is probuphine implant?
PROBUPHINE is an implant that contains the medicine buprenorphine. PROBUPHINE is used to treat certain adults who are addicted to (dependent on) opioid drugs (either prescription or illegal). PROBUPHINE is part of a complete treatment program that also includes counseling and behavioral therapy.
Where is probuphine implanted?
Probuphine consists of four, one-inch-long rods that are implanted under the skin on the inside of the upper arm and provide treatment for six months.May 26, 2016
What drug class is buprenorphine?
Buprenorphine is in a class of medications called opioid partial agonist-antagonists and naloxone is in a class of medications called opioid antagonists.Jan 12, 2022
Is Probuphine covered by insurance?
Official Answer. Probuphine (buprenorphine) is covered by most private insurance companies, Medicare plans and Medicaid.May 12, 2021
Why was Probuphine discontinued?
Why was Probuphine (buprenorphine) discontinued? In October 2020, Titan Pharmaceuticals announced that they were withdrawing Probuphine (buprenorphine) from the U.S. market. The company states that this was a business decision and not related to the safety of the product.
How do you take buprenorphine sublingual?
Place the medication under your tongue for 5 to 10 minutes and let it dissolve completely. If you are prescribed more than one tablet each day, you may place all of the tablets under your tongue at once or place two tablets at a time under your tongue. Do not swallow or chew this medication.
How much does Probuphine cost?
Implantable Buprenorphine (Probuphine) for Maintenance Treatment of Opioid Use DisorderDrugDosageCostImplantable buprenorphine (Probuphine)Four 74.2-mg implants$5,175 ($1,294 per implant)May 15, 2018
Is Bunavail the same as Suboxone?
The difference in bioavailability of BUNAVAIL compared to SUBOXONE sublingual tablet requires a different dosage strength to be administered to the patient. A BUNAVAIL 4.2 mg/0.7 mg buccal film provides equivalent buprenorphine exposure to a SUBOXONE 8 mg/2 mg sublingual tablet.
Is buprenorphine a Schedule II drug?
Control Status: Buprenorphine and all products containing buprenorphine are controlled in schedule III of the Controlled Substances Act.
Can buprenorphine be prescribed for pain?
Buprenorphine (Belbuca) is used to relieve severe pain in people who are expected to need pain medication around the clock for a long time and who cannot be treated with other medications. Buprenorphine (Belbuca) should not be used to treat pain that can be controlled by medication that is taken as needed.Jan 12, 2022
Why is naloxone added to buprenorphine?
Naloxone is added to buprenorphine to decrease the likelihood of diversion and misuse of the combination drug product. When these products are taken as sublingual tablets, buprenorphine's opioid effects dominate naloxone and blocks opioid withdrawals.Sep 11, 2020
What is level 2 of HCPCS?
The HCPCS Level II Code Set is one of the standard code sets used for medical claims processing of office administered drugs. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of CPT® (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT® is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT® to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT® codes are made by the AMA. The CPT® codes are republished and updated annually by the AMA. Level I of the HCPCS, the CPT® codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.
Is buprenorphine a partial opioid agonist?
PROBUPHINE contains buprenorphi ne, a partial opioid agonist. Probuphine is indicated for the maintenance treatment of opioid dependence in patients who have achieved and sustained prolonged clinical stability on low-to-moderate doses of a transmucosal buprenorphine-containing product (i.e., doses of no more than 8 mg per day of Subutexor Suboxonesublingual tablet equivalent or generic equivalent).
Can you take buprenorphine with a prescription?
Although some patients may require occasional supplemental dosing with buprenorphine, patients should not be provided with prescriptions for transmucosal buprenorphine-containing products for as-needed use. Instead, patients who feel the need for supplemental dosing should be seen and evaluated promptly.
What is the Drug Addiction Treatment Act?
Drug Addiction Treatment Act. Under the Drug Addiction Treatment Act (DATA ) codified at 21 United States Code (U.S.C.) 823 (g), use of this product in the treatment of opioid dependence is limited to Healthcare Providers who meet certain qualifying requirements, and who have notified the Secretary of Health and Human Services (HHS) ...
How long does it take for a probuphine implant to be removed?
PROBUPHINE subdermal implants are intended to be in place for 6 months of treatment. Remove PROBUPHINE implants by the end of the sixth month .
Can you use naloxone for opioid overdose?
Because patients being treated for opioid use disorder have the potential for relapse, putting them at risk for opioid overdose, strongly consider prescribing naloxone for the emergency treatment of opioid overdose, both when initiating and renewing treatment with PROBUPHINE.
Can you replace a probuphine implant?
There is no clinical experience with insertion of PROBUPHINE beyond a single insertion in each arm. If continued treatment is desired at the end of the first six-month treatment cycle, PROBUPHINE implants may be replaced by new implants at the time of removal in the contralateral arm, following the insertion steps above to locate the appropriate insertion site.
What is Probuphine?
Probuphine is an implant that contains the medicine buprenorphine. Probuphine is used to treat certain adults who are addicted to (dependent on) opioid drugs (either prescription or illegal). Probuphine is a part of a complete treatment program that also includes counseling and behavioral therapy.
How does Probuphine Work?
Four implants are inserted under the skin of your upper arm during a procedure done in your physician's office or Opioid Treatment Program (OTP).
What are the Risks Related to the Insertion and Removal of Probuphine Implants?
There is a risk of accidental overdose, abuse, and misuse for others if the implants come out and others are exposed to them.
What Should I do After the Probuphine Implants Have Been Inserted?
Follow your doctor's instructions for wound care of the place where the implants were inserted or removed.
Where Can I Get More Information About Probuphine?
What You Need to Know about Probuphine: A Patient’s Guide The healthcare provider who prescribes Probuphine for you will give this guide to you to help you understand the risks and benefits of Probuphine. This helpful guide is also available by clicking here.
How long is a buprenorphine implant?
Probuphine (buprenorphine) implant is a sterile, single, off-white, soft, flexible rod-shaped drug product. It is 26 mm in length and 2.5 mm in diameter . Each implant contains 74.2 mg buprenorphine (equivalent to 80 mg buprenorphine hydrochloride) and ethylene vinyl acetate (EVA). Probuphine is designed to be implanted subdermally by a trained medical professional and to provide sustained delivery of buprenorphine for up to six months.
What is UnitedHealthcare medical benefit drug policy?
This Medical Benefit Drug Policy provides assistance in interpreting UnitedHealthcare standard benefit plans. When deciding coverage, the federal, state or contractual requirements for benefit plan coverage must be referenced as the terms of the federal, state or contractual requirements for benefit plan coverage may differ from the standard benefit plan. In the event of a conflict, the federal, state or contractual requirements for benefit plan coverage govern. Before using this policy, please check the federal, state or contractual requirements for benefit plan coverage.
Does Medicare cover Sublocade?
Medicare does not have a National Coverage Determination (NCD) specific to the use of Probuphine® and SUBLOCADE™ for treatment of moderate to severe addiction (dependence) to opioid drugs. Local Coverage Determinations (LCDs) do not exist at this time.
What is the J code for buprenorphine?
today announced that the Centers for Medicare & Medicaid Services (CMS) has granted a Healthcare Common Procedure Coding System (HCPCS) code, or permanent J-code, for Probuphine, the first and only six-month buprenorphine implant for the maintenance treatment of opioid addiction. The new J-code (J0570) became effective January 1, 2017 and coincides with the activation of a new field force to drive the next phase of Probuphine adoption.
What is Braeburn Pharmaceuticals?
Braeburn Pharmaceuticals, an Apple Tree Partners company, is a commercial-stage pharmaceutical company delivering individualized medicine in neuroscience. Long-acting therapeutic treatment options can be essential to improving patient outcomes and facilitating recovery in neurological and psychiatric disorders, which are often complicated by stigma and present significant public health challenges. Braeburn's commercial product, Probuphine ® (buprenorphine) implant was approved by the FDA in May 2016. Braeburn's investigational product pipeline consists of long-acting implantable and injectable therapies for serious neurological and psychiatric disorders, including opioid addiction, pain, and schizophrenia. Braeburn's pipeline products are at various stages of clinical development and include weekly and monthly CAM2038, subcutaneous injection depot formulations of buprenorphine, being investigated in opioid addiction and pain, BB0417 buprenorphine/granisetron injectable for acute pain, and BB0817, six-month risperidone implant being investigated in schizophrenia. More information on Braeburn can be found at www.braeburnpharmaceuticals.com.
Indications and Usage
- Probuphine is indicated for the maintenance treatment of opioid dependence in patients who have achieved and sustained prolonged clinical stability on low-to-moderate doses of a transmucosal buprenorphine-containing product (i.e., doses of no more than 8 mg per day of Su…
Dosage and Administration
- . Drug Addiction Treatment Act
Under the Drug Addiction Treatment Act (DATA) codified at 21 United States Code (U.S.C.) 823(g), use of this product in the treatment of opioid dependence is limited to Healthcare Providers who meet certain qualifying requirements, and who have notified the Secretary of Health and Human … - . Important Dosage and Administration Information
Probuphine implants should be used only in patients who are opioid tolerant. Each dose consists of four Probuphine implants inserted subdermally in the inner side of the upper arm. Probuphine subdermal implants are intended to be in place for 6 months of treatment. Remove Probuphine i…
Dosage Forms and Strengths
- Each Probuphine implant is a sterile, single, off-white, soft, flexible, rod-shaped ethylene vinyl acetate (EVA) implant, 26 mm in length and 2.5 mm in diameter, containing 74.2 mg of buprenorphine (equivalent to 80 mg of buprenorphine hydrochloride).
Contraindications
- Probuphine is contraindicated in patients with a history of hypersensitivity to buprenorphine or any other ingredients in Probuphine (e.g., EVA) [see Warnings and Precautions (5.11)].
Warnings and Precautions
- . Serious Complications From Insertion and Removal of Probuphine
Rare but serious complications including nerve damage and migration resulting in embolism and death may result from improper insertion of drug implants inserted in the upper arm. Additional complications may include local migration, protrusion, and expulsion. Insert Probuphine in accor… - . Probuphine REMS Program
Probuphine is available only through a restricted program under a REMS, called the Probuphine REMS Program, because of the risk of complications of migration, protrusion and expulsion, and nerve damage associated with the insertion and removal of Probuphine [see Warnings and Prec…
Adverse Reactions
- The following adverse reactions are discussed in more detail in other sections of the labeling: 1. Serious Complications from Insertion and Removal of Probuphine [see Warnings and Precautions (5.1)] 2. Addiction, Abuse, and Misuse [see Warnings and Precautions (5.3)] 3. Respiratory and CNS Depression [see Warnings and Precautions (5.4, 5.5)] 4. Neonatal Opioid Withdrawal Syndr…
Use in Specific Populations
- . Pregnancy
Risk Summary The data on use of buprenorphine, the active ingredient in Probuphine implant, in pregnancy, are limited; however, these data do not indicate an increased risk of major malformations specifically due to buprenorphine exposure. There are limited data from randomi… - . Lactation
Risk Summary Based on two studies in 13 lactating women maintained on sublingual buprenorphine treatment, buprenorphine and its metabolite norbuprenorphine were present in low levels in human milk and available data have not shown adverse reactions in breastfed infants. …
Overdosage
- Clinical Presentation The manifestations of acute buprenorphine overdose include pinpoint pupils, sedation, hypotension, respiratory depression, and death. Treatment of Overdose In case of overdose, priorities are the re-establishment of a patent and protected airway and institution of assisted ventilation, if needed. Employ other supportive measures (including oxygen, vasopress…
Description
- Probuphine (buprenorphine) implant is a sterile, single, off-white, soft, flexible rod-shaped drug product. It is 26 mm in length and 2.5 mm in diameter. Each implant contains 74.2 mg buprenorphine (equivalent to 80 mg buprenorphine hydrochloride) and ethylene vinyl acetate (EVA). Probuphine is designed to be implanted subdermally by a trained medical professional an…