Ordering and reimbursement
>90% of covered lives have access to PYLARIFY®
To better serve patients with prostate cancer, the Lantheus Market Access Leader team and dedicated Support Hotline offer a suite of services designed to assist providers and patients with Lantheus products. Our team of reimbursement and payer specialists provide answers about:
- insurance coverage
- billing and coding
- prior authorization questions
- ongoing patient support
For questions on reimbursement for patients, providers, and payers, please call the Reimbursement Hotline at 844-339-8514.
Reimbursement support includes:
- Billing, Coding, and Claims Information for PYLARIFY (piflufolastat F 18) Injection and related procedures
- Coverage for Specific Payers: We can assist with claims and coverage issues for PYLARIFY and related procedures with your local and regional payers
- Radiology Benefit Managers (RBMs): While payers pay your claims, many have handed coverage off to their RBM partners. These partners develop clinical coverage guidelines that will determine what procedures will be approved—we can provide support to establish coverage and assist in pre-authorization of claims with the RBMs you deal with
- Benefit Investigation: The Hotline will verify patient insurance benefits, including deductible and copayments, any prior authorization requirements, and determine any possible coverage restrictions such as to network or place of service
- Prior Authorization (PA) Assistance: If PA is required, we will work with providers so that they can submit a request for prior authorization.
- Appeal/Peer-to-Peer Assistance: When a claim is denied, we offer assistance on appealing the denial with the payer
Reimbursement resources
PYLARIFY Coding and Billing Guide
Includes PYLARIFY billing codes (NDC, Diagnosis/ICD 10 code[s], CPT, HCPCS [J-code, A-code]), as well as details about PYLARIFY access and reimbursement support services
PYLARIFY Access and Reimbursement Best Practices Guide
Includes recommendations for inquiring with a patient’s payer prior to administration, managing expectations for cost and coverage, steps to take upon potential denials, and reimbursement scenarios/cases
