Billing and Coding: Omalizumab and biosimilar, OMLYCLO® (omalizumab-igec)

Omalizumab (OMLYCLO®) is covered when administered in a clinic or office by a physician or incident-to a physician, with dose and frequency consistent with the FDA label or recognized compendia. Patients must be treated in a healthcare setting with documented pre-treatment clinical assessment (including spirometry for asthma) and observed post-injection by providers prepared to manage anaphylaxis; self-administration and use for acute bronchospasm/status asthmaticus are not covered.

"Omalizumab is covered when administered by a physician or incident-to a physician’s service in a clinic or office setting."

Sign up to see full coverage criteria, indications, and limitations.