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 diagnosis and CPT procedure codes associated with each patient’s diagnosis and care
  • Use the correct HCPCS code (J-code or C-code) and appropriate units; only report 1 unit of ZILRETTA™ (triamcinolone acetonide extended-release injectable suspension) per injection when using the NOC code1
  • Include drug-identifying information in the areas designated for comments on the claim forms (format varies by health plan)
  • Complete all fields accurately and provide information upon request
  • Make sure your EMR is up-to-date and includes ZILRETTA (contact a FlexForward Case Manager if you’re having issues submitting claims for ZILRETTA with your EMR)

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
  • When using an NOC code, remember to include supporting documentation, such as the ZILRETTA Prescribing Information, FDA approval letter, and letter of medical necessity, with the claim
For questions regarding coding and billing for ZILRETTA, contact your Flexion Representative or call a FlexForward Case Manager at 1-844-FLEXION (1-844-353-9466), Monday – Friday, 8 AM8 PM EST.

CPT=Current Procedural Terminology; EMR=electronic medical record; HCPCS=Healthcare Common Procedure Coding System; ICD-10=International Classification of Diseases, 10th Revision; NOC=Not-Otherwise-Classified.