Access and Reimbursement: Tips and Reminders for Submitting a Claim

Submitting claim forms

Ensure all patient information (name, address, insurance ID) is accurate
Verify the name of the healthcare provider and National Provider Identifier (NPI)
Use the most appropriate ICD-10-CM diagnosis and CPT procedure codes associated with each patient’s diagnosis and care¹
Be sure to use the permanent, product-specific J-code (J3304) and bill 32 units of ZILRETTA per injection
Complete all fields accurately and provide information upon request
Contact provider services at the health plan to determine the reimbursement rate for ZILRETTA® (triamcinolone
acetonide extended-release injectable suspension) prior to billing and make sure your system is updated to
bill appropriately

Additional documentation

Ensure patient medical records contain documentation that supports the diagnosis and procedure codes submitted on the claim
Keep in mind your practice may need to pull supporting documentation, such as patient history, from the EMR
Access our Tools and Resources for additional support with letters of medical necessity and appeals

For questions regarding coding and billing for ZILRETTA, contact your dedicated Pacira representative or call a dedicated FlexForward Case Manager at 1-844-353-9466, Monday – Friday, 8 AM – 8 PM ET.

CPT=Current Procedural Terminology; EMR=electronic medical record; ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification.

Indication and Important Safety Information

Indication

ZILRETTA® (triamcinolone acetonide extended-release injectable suspension) is indicated as an intra-articular injection for the management of osteoarthritis pain of the knee.

Limitation of Use: The efficacy and safety of repeat administration of ZILRETTA have not been demonstrated.

Contraindication

ZILRETTA is contraindicated in patients who are hypersensitive to triamcinolone acetonide, corticosteroids, or any components of the product.

Warnings and Precautions

Intra-articular Use Only: ZILRETTA has not been evaluated and should not be administered by epidural, intrathecal, intravenous, intraocular, intramuscular, intradermal, or subcutaneous routes. Serious events have been reported with epidural and intrathecal administration of corticosteroids and none are approved for this use. ZILRETTA should not be considered safe for epidural or intrathecal administration.
Hypersensitivity Reactions: Rare instances of anaphylaxis, including serious cases, have occurred in patients with hypersensitivity to corticosteroids.
Joint Infection and Damage: A marked increase in pain accompanied by local swelling, restriction of joint motion, fever, and malaise are suggestive of septic arthritis. Examine joint fluid to exclude a septic process. If diagnosis is confirmed, institute appropriate antimicrobial therapy. Avoid injecting corticosteroids into a previously infected or unstable joint. Intra-articular administration may result in damage to joint tissues.
Increased Risk of Infections: Infection with any pathogen in any location of the body may be associated with corticosteroid use. Corticosteroids may increase the susceptibility to new infection and decrease resistance and the ability to localize infection.
Alterations in Endocrine Function: Corticosteroids can produce reversible hypothalamic-pituitary-adrenal axis suppression, with potential for adrenal insufficiency after withdrawal of treatment, which may persist for months. In situations of stress during that period, institute corticosteroid replacement therapy.
Cardiovascular and Renal Effects: Corticosteroids can cause blood pressure elevation, salt and water retention, and increased potassium excretion. Monitor patients with congestive heart failure, hypertension, and renal insufficiency for edema, weight gain, and electrolyte imbalance. Dietary salt restriction and potassium supplementation may be needed.
Increased Intraocular Pressure: Corticosteroid use may be associated with increased intraocular pressure. Monitor patients with elevated intraocular pressure for potential treatment adjustment.
Gastrointestinal Perforation: Corticosteroid administration may increase risk of gastrointestinal perforation in patients with certain GI disorders and fresh intestinal anastomoses. Avoid corticosteroids in these patients.
Alterations in Bone Density: Corticosteroids decrease bone formation and increase bone resorption. Special consideration should be given to patients with or at increased risk of osteoporosis prior to treatment.
Behavior and Mood Disturbances: Corticosteroids may cause adverse psychiatric reactions. Prior to treatment, special consideration should be given to patients with previous or current emotional instability or psychiatric illness. Advise patients to immediately report any behavior or mood disturbances.

Adverse Reactions

The most commonly reported adverse reactions (incidence ≥1%) in clinical studies included sinusitis, cough, and contusions.

Please see full Prescribing Information.

Tips and reminders for submitting a claim

Submitting claim forms

Additional documentation