Ordering and Reimbursement
Order VABOMERE™ (meropenem and vaborbactam) Using Standard Ordering Procedure Through Your Wholesaler
- VABOMERE is a wholesaler-stocked product
- If VABOMERE is not available at your wholesaler, the wholesaler can coordinate a drop shipment via Next Day Saver from a Melinta primary distribution provider
- Download the Order Sheet for more information
2 single-dose vials = 4 g dose
VABOMERE™ 4 g (2 g meropenem and2 g vaborbactam)
Coding and Reimbursement
Covers the coding requirements, coding systems, and their application when VABOMERE is administered
- Lists ICD-10 codes and transition of care codes to facilitate timely claims processing and reduce the risk of denied claims
- Addresses coverage and payment information pertaining to Medicare, Medicaid, and commercial payers, in inpatient and outpatient settings including long-term acute care and home infusion reimbursement
- Includes sample CMS 1450 and CMS 1500 billing forms
- See Coding and Billing Reference Guide for details
New Technology Add-on Payments (NTAP) for VABOMERE Effective October 1, 2018
Under the Medicare program, the Centers for Medicare and Medicaid Services (CMS) provides a process for identifying and ensuring adequate payment for new medical services and technologies. In particular, technologies that qualify as “new” and meet certain other specified criteria may be considered for “new technology add-on payments" (NTAP).
NTAP is an add-on payment that applies to Medicare inpatients only; specifically, it is an additional payment to the Diagnostic Related Group (DRG)-based reimbursement that otherwise applies to the reimbursement paid for a Medicare beneficiary’s inpatient stay.
Effective October 1, 2018, the start of the 2019 fiscal year, Medicare inpatient stays that involve the administration of VABOMERE may be eligible for NTAP. As determined by CMS, $5,544 is the maximum NTAP amount for a Medicare inpatient case involving the administration of VABOMERE in FY 2019.
Please check back prior to October 1st for additional information, including coding and an updated Reimbursement Guide.
The content of this guide is general in nature, strictly for informational purposes only, and does not cover all situations or all payers’ policies and guidance. The information provided in this guide was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, policies, and payment amounts. This guide is not intended to provide clinical practice guidelines.
Melinta Therapeutics, Inc. (Melinta) cannot guarantee, and is not responsible for, the payment of any claim. The coding, coverage, and payment of VABOMERE may vary by payer, plan, patient, and setting of care. Coding determinations and analysis should always be independently researched and assessed. For more information, please check with individual payers for specific coding, coverage, and payment requirements. It is the sole responsibility of the healthcare provider to code properly and to ensure the accuracy of all claims submitted for reimbursement. Additionally, as a prerequisite for submitting a claim, the provider is responsible for ensuring that all services are medically necessary and properly supported in the patient’s medical records. Melinta specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this guide.
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Reference: 1. Vabomere [package insert]. Lincolnshire, IL: Melinta Therapeutics, Inc.; 2018.