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ACTEMRA® (tocilizumab)‎ ALECENSA® (alectinib) Avastin® (bevacizumab) COLUMVI™ (glofitamab-gxbm) COTELLIC® (cobimetinib) ENSPRYNG® (satralizumab-mwge) Erivedge® (vismodegib) Evrysdi® (risdiplam) GAZYVA® (obinutuzumab) HEMLIBRA® (emicizumab-kxwh) Herceptin® (trastuzumab) Herceptin HYLECTA™ (trastuzumab and hyaluronidase-oysk) Itovebi™ (inavolisib) KADCYLA® (ado-trastuzumab emtansine) LUCENTIS® (ranibizumab injection) LUNSUMIO™ (mosunetuzumab-axgb) OCREVUS® (ocrelizumab) and OCREVUS ZUNOVO™ (ocrelizumab & hyaluronidase-ocsq) PERJETA® (pertuzumab) PHESGO™ (pertuzumab, trastuzumab, and hyaluronidase-zzxf) PiaSky™ (crovalimab-akkz) POLIVY® (polatuzumab vedotin-piiq) Pulmozyme® (dornase alfa) Inhalation Solution Rituxan® (rituximab) for Rheumatoid Arthritis (RA) RITUXAN® (rituximab) for Oncology Rituxan® (rituximab) for Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) RITUXAN HYCELA® (rituximab/hyaluronidase human) ROZLYTREK® (entrectinib) SUSVIMO™ (ranibizumab injection) TECENTRIQ® (atezolizumab) TECENTRIQ HYBREZA™ (atezolizumab and hyaluronidase-tqjs) VABYSMO® (faricimab-svoa) VENCLEXTA® (venetoclax tablets) XOLAIR® (omalizumab) for subcutaneous use ZELBORAF® (vemurafenib) Oncology Ophthalmology Rheumatology

ACTEMRA® (tocilizumab)‎ ALECENSA® (alectinib) Avastin® (bevacizumab) COLUMVI™ (glofitamab-gxbm) COTELLIC® (cobimetinib) ENSPRYNG® (satralizumab-mwge) Erivedge® (vismodegib) Evrysdi® (risdiplam) GAZYVA® (obinutuzumab) HEMLIBRA® (emicizumab-kxwh) Herceptin® (trastuzumab) Herceptin HYLECTA™ (trastuzumab and hyaluronidase-oysk) Itovebi™ (inavolisib) KADCYLA® (ado-trastuzumab emtansine) LUCENTIS® (ranibizumab injection) LUNSUMIO™ (mosunetuzumab-axgb) OCREVUS® (ocrelizumab) and OCREVUS ZUNOVO™ (ocrelizumab & hyaluronidase-ocsq) PERJETA® (pertuzumab) PHESGO™ (pertuzumab, trastuzumab, and hyaluronidase-zzxf) PiaSky™ (crovalimab-akkz) POLIVY® (polatuzumab vedotin-piiq) Pulmozyme® (dornase alfa) Inhalation Solution Rituxan® (rituximab) for Rheumatoid Arthritis (RA) RITUXAN® (rituximab) for Oncology Rituxan® (rituximab) for Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) RITUXAN HYCELA® (rituximab/hyaluronidase human) ROZLYTREK® (entrectinib) SUSVIMO™ (ranibizumab injection) TECENTRIQ® (atezolizumab) TECENTRIQ HYBREZA™ (atezolizumab and hyaluronidase-tqjs) VABYSMO® (faricimab-svoa) VENCLEXTA® (venetoclax tablets) XOLAIR® (omalizumab) for subcutaneous use ZELBORAF® (vemurafenib) Oncology Ophthalmology Rheumatology

Reimbursement

XOLAIR Sample Coding Appeals

XOLAIR Sample Coding

This coding information may assist you as you complete the payer forms for XOLAIR. These tables are provided for informational purposes only. Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding for single-use vials and wastage.

Download sample coding information for XOLAIR below. "Download Selected" lets you download and print all selected coding tables.

Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech and Novartis Pharmaceuticals Corporation do not make any representation or guarantee concerning reimbursement or coverage for any item or service.

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  • Complete and submit a form electronically.

Appeals

If your patient’s health insurance plan has issued a denial, your Field Reimbursement Manager (FRM) or XOLAIR Access Solutions Specialist can provide resources as you prepare an appeal submission, as per your patient’s plan requirements.

If a plan issues a denial:

  1. The denial should be reviewed, along with the health insurance plan’s guidelines, to determine what to include in your patient’s appeal submission.
  2. Your FRM or XOLAIR Access Solutions Specialist has local payer coverage expertise and can help you determine specific requirements for your patient.

A sample appeal letter and additional considerations for appeals are available in Forms and Documents.

Appeals cannot be completed or submitted by XOLAIR Access Solutions on your behalf.

phone

For assistance, call (877) GENENTECH/(877) 436-3683
6 a.m.–5 p.m. PT, Monday through Friday