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XGEVA INJECTION WITHIN 6 MOS OF PROLIA (WITH new DX of BONE METS)?

Patricia Posted Wed 05th of October, 2016 10:03:01 AM
Could you tell me if Medicare will cover an injection for Xgeva if a patient has had Prolia less than six months prior? He is newly diagnosed with bone metastisis secondary to prostate CA.
SuperCoder Answered Thu 06th of October, 2016 02:33:13 AM

Hi Patricia,

Yes, medicare can bill Xgeva even if a patient had Prolia less than six months prior. However, it should be recommended by doctor as medical necessity. Also, since patient is newly diagnosed with bone metastisis so it is ok to bill Xgeva.

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