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
  • Confirm the correct HCPCS code with patient’s health plan
  • Bill the appropriate amount of units based on the code used
  • 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 Flexion Representative or call a dedicated FlexForward Case Manager at 1-844-FLEXION (353-9466), Monday – Friday, 8 AM8 PM ET.

CPT=Current Procedural Terminology; EMR=electronic medical record; HCPCS=Healthcare Common Procedure Coding System; ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification