Reimbursement Process and Coding Information for Hypermunes™
Information on Grifols Hypermunes Reimbursement Process
Both private and government payers process and reimburse claims for Hypermunes when they are administered in approved care facilities, such as emergency departments, hospital outpatient departments, physician offices, and local health departments. Medicare, Medicaid, Veterans Affairs (VA), and Tricare for the Department of Defense (DoD) represent the major government payers. Most private and commercial payers administer benefits through Managed Care Organizations (MCOs), which are primarily employer-based.
Coding for Grifols Hypermunes
When submitting claims to third-party payers, providers should accurately code the product and procedure.
- Product Billing Code—Each of the Hypermunes has its own unique Healthcare Common Procedure Coding System (HCPCS) code or Current Procedural Terminology® (CPT)* code as shown below
- Injection Procedure—In addition to the code that identifies the agent, the injection procedure has a CPT code. The administration CPT code is 96372—therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
Hypermunes code + injection procedure code = complete reimbursement
Grifols Hypermunes product billing codes. For additional reimbursement information, please see reimbursement codes below:
HyperRAB® (rabies immune globulin [human]) 300 IU/mL
HyperTET® S/D (tetanus immune globulin [human])
HyperRHO® S/D (RhO[D] immune globulin [human])
HyperHEP B® S/D (hepatitis B immune globulin [human])
GamaSTAN® (immune globulin [human])
*Current Procedural Terminology (CPT) is a registered trademark of the American Medical Association.
†NDC11 is used for billing purposes.
Optum, ICD-10-CM for Hospitals and Payers, Volumes 1, 2 and 3, publisher of the official code set issued by the Department of Health and Human Services.