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Reimbursement

For the treatment of pediatric patients with bilateral otitis media with effusion undergoing tympanostomy tube placement

Important Safety Information and Indications

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

OTIPRIO is contraindicated in patients with a history of hypersensitivity to ciprofloxacin, to other quinolones, or to any of the components of OTIPRIO.

Reimbursement Tools and Information

New J-Code Approved for OTIPRIO!

J7342 installation, ciprofloxacin otic suspension, 6 mg
Please refer to the Billing and Coding Guide for more information

Customer Reimbursement Support: Introducing Otonomy Answers!

Telephone: 1-844-684-7746
Fax: 1-800-418-0274
Monday through Friday, 8:00 AM – 8:00 PM ET, excluding major holidays

Otonomy Answers is a customer reimbursement support program that offers the following services:

Provider Education: Live-answer billing and coding support and a Field Reimbursement Team that can provide in-person training on billing and coding for OTIPRIO® (ciprofloxacin otic suspension) 6%.
Benefit Investigation: An Otonomy Answers reimbursement specialist will contact the patient’s insurer to collect information on benefits and reimbursement for OTIPRIO.
Prior Authorization Support: An Otonomy Answers reimbursement specialist will provide information on the prior authorization submission process to the patient’s insurer and conduct necessary follow-up with the insurer until a decision is rendered.
Appeals Support: An Otonomy Answers reimbursement specialist will provide information on the appeal submission process to the patient’s insurer and conduct necessary follow-up with the insurer until a decision is rendered.
Claim Review: An Otonomy Answers reimbursement specialist will review a patient claim to identify potential billing errors. This may also include calling the patient’s insurer to obtain additional information about the claim and its adjudication.

Reimbursement materials

Otonomy has developed various resources to assist providers with reimbursement-related questions about OTIPRIO.

Billing and Coding Guide

Quick Coding Reference

ICD-9-CM ICD-10-CM Crosswalk

Pass-Through Status/C-Code Announcement

CMS 1450 Form

Otonomy Answers Intake Form

Materials and information provided are intended solely for educational purposes regarding possible codes to report for use of OTIPRIO. The information provided contains general reimbursement information only and represents Otonomy’s understanding of current reimbursement policies at the time of the material publication. Information should not be construed as legal advice nor is it advice about how to code, complete, or submit any particular claim for payment. Coding and reimbursement information is subject to change. Information provided is not intended to increase or maximize reimbursement by any payer.

Otonomy disclaims any responsibility for claims submitted by providers or physicians. All coding and billing to payers must be truthful and not misleading and make full disclosures to the payer about the product and the procedures associated with its use when seeking reimbursement for any product or procedure. It is the provider’s and physician’s responsibility to determine appropriate codes, charges, and modifiers, and to submit bills for services and products consistent with what was rendered as well as the patient’s insurer requirements. Third-party payers may have different coverage and reimbursement policies and coding requirements. Such policies can change over time. Providers are encouraged to contact third-party payers for each patient to verify specific information on their coding policies.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

OTIPRIO is contraindicated in patients with a history of hypersensitivity to ciprofloxacin, to other quinolones, or to any of the components of OTIPRIO.

WARNINGS AND PRECAUTIONS

Potential for Microbial Overgrowth: OTIPRIO may result in overgrowth of nonsusceptible bacteria and fungi. If such infections occur, institute alternative therapy.

ADVERSE REACTIONS

Adverse reactions (incidence at least 3%) that occurred in two Phase 3 trials with OTIPRIO vs sham were: nasopharyngitis (5% vs 4%), irritability (5% vs 3%), and rhinorrhea (3% vs 2%).

USE IN SPECIFIC POPULATIONS

Pediatric Use: The safety and effectiveness of OTIPRIO in infants below six months of age have not been established.

Indications and Usage

OTIPRIO® (ciprofloxacin otic suspension) 6% is a fluoroquinolone antibacterial indicated for the treatment of pediatric patients with bilateral otitis media with effusion undergoing tympanostomy tube placement.

Please see full Prescribing Information.