Billing and Coding: Ibandronate Sodium

Intravenous ibandronate sodium is covered when bisphosphonate therapy is indicated but the patient cannot tolerate oral bisphosphonates or has a medical contraindication; documentation of intolerance or contraindication (including severe esophagitis where relevant) is required. It is an accepted treatment option for osteoporosis (including transplant-related osteoporosis) under those conditions and for hypercalcemia of malignancy with documented rationale; dosing and frequency must follow the FDA label or recognized compendia (IV formulation FDA-approved every three months). Preventive use in postmenopausal women without osteopenia is not payable and must be billed with modifier -GY, which will result in denial.

"Intravenous ibandronate sodium is reasonable and necessary only for patients for whom bisphosphonate therapy (including oral ibandronate) is medically indicated and who cannot tolerate oral therapy..."