TORISEL Billing and Reimbursement

The TORISEL Reimbursement Support Program is a one-stop resource for your reimbursement and patient access needs.

One call connects you to your dedicated Regional Reimbursement Consultant (RRC), who is ready to handle your reimbursement questions about TORISEL.

Contact Information

Phone: 1-866-WYETH-ONC (1-866-993-8466)
Fax: 1-866-993-8411
Monday – Friday, 9am – 6pm, Eastern Time

TORISEL Reimbursement Support Program
P.O. Box 220907
Charlotte, NC  28222-0907

J Code for TORISEL

TORISEL now has a product-specific J code: J9330. Please note that this J code represents 1 mg and 1 mg equals
1 billable unit. J9330 should be used in the appropriate field of the CMS 1500 form when administering temsirolimus in an office-based setting.¹

A permanent J code for temsirolimus enables you to submit claims in a more timely, accurate, and consistent manner. It also allows you to submit claims for TORISEL in the same electronic format that you use for other products routinely prescribed and administered. Lastly, it provides a singular product billing code to be used across all insurance carriers.

Reimbursement Services

The reimbursement services provided by the TORISEL Reimbursement Support Program are designed to ease the administrative burden providers face when working with their patients’ insurers. Services include

• Research into patient-specific coverage for TORISEL
• Identification of TORISEL coverage policy for federal, state, and private payers
• Research to identify alternatives for patients with inadequate or no coverage, including assessment of the patient’s eligibility to participate in the TORISEL Patient Assistance Program
• Comprehensive prior authorization support
• Coding and claims filing assistance
• Claims tracking assistance to routinely monitor status of TORISEL claims
• Claims denial appeal assistance

Patient Assistance Program

The TORISEL Patient Assistance Program offers product for patients who lack adequate coverage for TORISEL and meet program guidelines.

• To determine if your patient qualifies for assistance, a health care professional need only submit the Patient Enrollment Form and HIPAA Authorization. (Providers seeking assistance for the first time will be asked to complete the one-time Physician Enrollment form.)
  Get TORISEL billing and reimbursement forms now.
• Your dedicated RRC will review the patient’s eligibility and usually provide a response within 2 business days of receiving the completed enrollment.
• Eligible patients receive assistance in the form of free product, which is distributed on a monthly basis to the treating provider.

Product Replacement Program

The TORISEL Patient Assistance Program allows for product replacement under certain circumstances. Product replacement is available for patients who have been provided TORISEL and who then have their insurance claims fully denied after an appeal. If a patient met the other eligibility criteria for the Patient Assistance Program at the time TORISEL was administered, the product the patient received may be replaced.

• The provider and patient will be asked to submit the same application forms as the PAP.
• The RRC will review the patient’s eligibility, including investigation of the patient’s insurance benefits.
• Your RRC can provide further details and requirements for the availability of product replacement.

Billing and Reimbursement Guide

Wyeth Pharmaceuticals developed a detailed guide to assist providers with understanding coding coverage and payment of TORISEL for key payers and provider types. Get a copy of the TORISEL Billing and Reimbursement Guide.

Patient Assistance Forms

Find downloadable reimbursement-related forms on this Web site, including the Patient Enrollment Form, Physician Enrollment Form, HIPAA Authorization, and template letters for reimbursement requests and appeals. Get TORISEL billing and reimbursement forms now.

 

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