What is SCENESSE®?
SCENESSE® is a prescription medication that contains the active substance afamelanotide. Afamelanotide is used to increase tolerance to the sun and light in adults with a confirmed diagnosis of erythropoietic protoporphyria (EPP). EPP is a condition in which patients have an increased sensitivity to sunlight and artificial light sources.
How does SCENESSE® work?
SCENESSE® (pronounced “sen-esse”) acts by increasing the levels of eumelanin in the skin, shielding against UV radiation (UVR) and visible light, including sunlight.
Afamelanotide is a synthetic form of a hormone called alpha-melanocyte stimulating hormone (α-MSH). Afamelanotide works in a way similar to the natural hormone, by making skin cells produce eumelanin which is a brown-black type of melanin pigment in the skin. By increasing the amount of eumelanin and acting as an antioxidant, SCENESSE® can help to reduce the sensitivity of the skin to sunlight and artificial UV light sources.
What are the ingredients in SCENESSE®?
Active ingredient: afamelanotide (16mg)
Inactive ingredient: Poly (DL-lactide-co-glycolide), a bioresorbable polymer
How is SCENESSE® administered?
SCENESSE® implant is given subcutaneously by a trained health care professional.
The implant is injected under your skin using a cannula and stylet (obturator).
Before inserting the implant, your doctor may decide to give you a local anesthetic to numb the area where the implant is to be inserted. The implant is inserted directly into the fatty area above your hip, known as the supra-iliac crest.
At the end of the insertion procedure, you may be able to feel the implant under your skin. Over time the implant will dissolve and be absorbed by the body, this will happen within 50 to 60 days after implantation.
A single SCENESSE® implant is administered every 2 months.
Possible billing codes for SCENESSE®
Correct coding is the responsibility of the provider submitting a claim for the item or service. Here we provide general billing and coding information for SCENESSE® and related services. Please check with the payor to verify coding or special billing requirements.
|ICD-10-CM Diagnosis Codes||Definition|
Please refer to the ICD-10-CM Manual for a complete description of the diagnosis code.
|J7352||Afamelanotide implant, 1mg|
|11981||Insertion, non-biodegradable drug delivery implant|
|73372-0116-1||16 mg of afamelanotide, bioresorbable implant.|
Some payors require physicians to report 11-digit NDCs when reporting a drug on a claim form. Converting the 10-digit NDC for SCENESSE® to an 11-digit NDC requires the use of a leading zero in the package size section of the NDC (i.e., the last section)
Please note: Other codes may also be appropriate for SCENESSE®. The codes provided are not exhaustive and additional codes may apply.
*The CPT code is supplied for informational purposes only and represent no statement, promise, or guarantee, expressed or implied, by CLINUVEL, INC. or its third-party service providers that these codes will be appropriate or that reimbursement will be made.
Prior Authorization Forms
The information provided is not a guarantee of coverage or payment (partial or full). Actual benefits are determined by each plan administrator in accordance with its respective policy and procedures.
The forms are presented for informational purposes only and is not intended to provide reimbursement or legal advice, nor does it promise or guarantee coverage, levels of reimbursement, payment, or charge. It is not intended to increase or maximize reimbursement by any Insurer. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. While CLINUVEL has made an effort to be current as of the issue date of this document, the information may not be as current or comprehensive when you view it. Please refer to the applicable plan’s website, or contact the plan for more information about coverage or any restrictions or prerequisites that may apply. We strongly recommend you consult the Insurer for its reimbursement policies.
ICD-10 = International Statistical Classification of Diseases and Related Health Problems 10th Revision, a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Available at:
J-code = J-codes are part of the Healthcare Common Procedure Coding System (HCPCS) codes that are assigned to drugs by the Centers for Medicare and Medicaid Services (CMS). Available at:
CPT = Current Procedural Terminology. CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. CPT 2018 Professional Edition. Chicago, Ill: American Medical Association, 2017
NDC Code = National Drug Code is a unique 10-digit, 3-segment numeric identifier assigned to each medication listed under Section 510 of the US Federal Food, Drug, and Cosmetic Act. The NDC number identifies the labeler, product, and trade package size.
Insurance Cost and Coverage Glossary
Patient’s share of the costs of a covered healthcare service, calculated as a percentage (for example, 20%) of the allowed amount for the service. The patient will pay co-insurance once the patient’s deductible has been met.
A fixed amount (for example, $25) the patient pays for a covered healthcare service, usually when the patient receives the service. The amount can vary by the type of covered healthcare service.
The amount the patient owes for healthcare services before his/her health insurance or plan begins to pay. For example, if the patient’s deductible is $1500, the patient’s plan won’t pay anything until the patient has met the $1500 deductible for covered healthcare services subject to the deductible. The deductible may not apply to all services.
The net amount that it costs the patient, after insurance payments and other forms of support are subtracted from the total cost.
Also known as: preauthorization, prior approval, or precertification. This is a decision by the patient’s health insurance or plan that a healthcare service, a treatment plan, a prescription drug, or durable medical equipment is medically necessary. The patient’s health insurance or plan may require preauthorization for certain services before the patient receives them, except in an emergency.
Prior Authorization isn’t a promise that the patient’s health insurance or plan will cover the cost. Actual benefits are determined by each plan administrator in accordance with its respective policy and procedures.