Biologics administered in the allergy office represent some of the highest-value claims in the specialty — and the most PA-intensive. Omalizumab (Xolair, J2357), dupilumab (Dupixent, J0223), mepolizumab (Nucala, J2182), benralizumab (Fasenra, J0517), tezepelumab (Tezspire, J3241) each require specific J-code billing with NDC documentation, dose-accurate quantity units, administration code billing (96372), and a prior authorization process that varies by drug, by indication, and by payer. Missing any component costs hundreds to thousands of dollars per visit.
J-code + NDC documentation required for every biologic claim
Dose-accurate unit count — dosing varies by weight and indication
96372 administration code separately billable in non-facility settings
PA management — each drug has distinct payer-specific criteria
Step therapy requirements must be documented pre-PA submission
J2357J0223J2182J0517J324196372