Learn More About Coding and Coverage
CODING & Billing
This website contains relevant National Drug Codes and billing codes that may be applicable
to you and your office staff.
Coding & Billing Information
The Sample CMS-1500 Form is a helpful resource that outlines important details and steps to
follow while completing
the CMS-1500 Form to ensure that all information and signatures are captured.
Sample CMS-1500 Form
(For Office-Based Physicians)
The Sample UB-04 Form is a helpful resource that outlines important details and steps to
follow while completing the UB-04 Form to ensure that all information and signatures are
captured.
Sample UB-04 Form
(For Hospital Outpatient Facilities)
COVERAGE & BENEFITS INFORMATION FOR KEYTRUDA
The Merck Access Program can contact insurers to obtain coverage and benefits information for
KEYTRUDA. Contact The Merck Access Program Mon-Fri, 8 AM to 8
PM (ET) at 855-257-3932.
PRIOR AUTHORIZATIONS
If a prior authorization (PA) is required, or for assistance in understanding if a PA is
required, The Merck Access Program may be able to help.
The PA checklist and sample letter can help you understand the documents and information that
may be helpful when seeking a PA. As always, you should check for payer-specific requirements.
PRIOR AUTHORIZATION CHECKLIST
Once The Merck Access Program enrollment form is submitted, you may be notified 24 to 48
business hours later if a PA
is needed for your patient. If needed, please work with The Merck Access Program and use
this checklist to ensure that all necessary materials and information are submitted to the
payer.
Prior Authorization Checklist
SAMPLE PRIOR AUTHORIZATION LETTER
Once The Merck Access Program enrollment form is submitted, you may be notified 24 to 48
business hours later if a PA is needed for your patient. If needed, please work with The
Merck Access Program and use this sample letter template to write a letter to the payer.
Sample Prior Authorization Letter
APPEALS
If you have submitted a claim and the claim has been denied, you can submit an appeal to your
patient’s insurer. The Merck Access Program may be able to help your office understand the
information needed for an appeal submission.
- The appeal checklist can help you understand the documents and
information that may be helpful when filing an appeal. As always, you should check for
payer-specific requirements.
Appeal Checklist
- The Sample Appeal Letter provides guidance that may be helpful
when filing an appeal for a denied claim.
Sample Appeal Letter
The information available here is compiled from sources believed to be accurate, but Merck makes no
representation that it is accurate. This information is subject to change. Payer coding requirements may
vary or change over time, so it is important to regularly check with each payer as to payer-specific
requirements.
The information available here is not intended to be definitive or exhaustive and is not intended to
replace the guidance of a qualified professional advisor. Merck and its agents make no warranties or
guarantees, expressed or implied, concerning the accuracy or appropriateness of this information for your
particular use given the frequent changes in public and private payer billing. The use of this information
does not guarantee payment or that any payment received will cover your costs.
You are solely responsible for determining the appropriate codes and for any action you take in billing.
Information about HCPCS codes is based on guidance issued by the Centers for Medicare & Medicaid
Services applicable to Medicare Part B and may not apply to other public or private payers. Consult the
relevant manual and/or other guidelines for a description of each code to determine the appropriateness of
a particular code and for information on additional codes. Diagnosis codes should be selected only by a
healthcare professional.
Learn More About Coding and Coverage
CODING & Billing
The Sample CMS-1500 Form is a helpful resource that outlines important details and steps to
follow while completing
the CMS-1500 Form to ensure that all information and signatures are captured.
Sample CMS-1500 Form
(For Office-Based Physicians)
The Sample UB-04 Form is a helpful resource that outlines important details and steps to
follow while completing the UB-04 Form to ensure that all information and signatures are
captured.
Sample UB-04 Form
(For Hospital Outpatient Facilities)
COVERAGE & BENEFITS INFORMATION FOR KEYTRUDA QLEX
The Merck Access Program can contact insurers to obtain coverage and benefits information for
KEYTRUDA QLEX. Contact The Merck Access Program Mon-Fri, 8 AM to 8
PM (ET) at 855-257-3932.
PRIOR AUTHORIZATIONS
If a prior authorization (PA) is required, or for assistance in understanding if a PA is
required, The Merck Access Program may be able to help.
The PA checklist and sample letter can help you understand the documents and information that
may be helpful when seeking a PA. As always, you should check for payer-specific requirements.
PRIOR AUTHORIZATION CHECKLIST
Once The Merck Access Program enrollment form is submitted, you may be notified 24 to 48
business hours later if a PA
is needed for your patient. If needed, please work with The Merck Access Program and use
this checklist to ensure that all necessary materials and information are submitted to the
payer.
Prior Authorization Checklist
SAMPLE PRIOR AUTHORIZATION LETTER
Once The Merck Access Program enrollment form is submitted, you may be notified 24 to 48
business hours later if a PA is needed for your patient. If needed, please work with The
Merck Access Program and use this sample letter template to write a letter to the payer.
Sample Prior Authorization Letter
APPEALS
If you have submitted a claim and the claim has been denied, you can submit an appeal to your
patient’s insurer. The Merck Access Program may be able to help your office understand the
information needed for an appeal submission.
- The appeal checklist can help you understand the documents and
information that may be helpful when filing an appeal. As always, you should check for
payer-specific requirements.
Appeal Checklist
- The Sample Appeal Letter provides guidance that may be helpful
when filing an appeal for a denied claim.
Sample Appeal Letter
The information available here is compiled from sources believed to be accurate, but Merck makes no
representation that it is accurate. This information is subject to change. Payer coding requirements may
vary or change over time, so it is important to regularly check with each payer as to payer-specific
requirements.
The information available here is not intended to be definitive or exhaustive and is not intended to
replace the guidance of a qualified professional advisor. Merck and its agents make no warranties or
guarantees, expressed or implied, concerning the accuracy or appropriateness of this information for your
particular use given the frequent changes in public and private payer billing. The use of this information
does not guarantee payment or that any payment received will cover your costs.
You are solely responsible for determining the appropriate codes and for any action you take in billing.
Information about HCPCS codes is based on guidance issued by the Centers for Medicare & Medicaid
Services applicable to Medicare Part B and may not apply to other public or private payers. Consult the
relevant manual and/or other guidelines for a description of each code to determine the appropriateness of
a particular code and for information on additional codes. Diagnosis codes should be selected only by a
healthcare professional.
