Reimbursement Support
Reimbursement Support
Zevalin Results Program
Downloadable Reimbursement Materials

Reimbursement Support - Download as a PDF document
Reimbursement assistance and information for your practice and your patients.

Zevalin Therapeutic Regimen Coding - Download as a PDF document

Zevalin Support Services Enrollment Form - Download as a PDF document

Sample Letter of Appeal - Download as a Word document

Sample Letter of Medical Necessity - Download as a Word document

Patients and Caregivers

Sample Claim Forms - Zevalin - Rituxan
UB92 Private Zevalin Form - Download as a Word or PDF document
UB92 Private Rituxan Form - Download as a Word or PDF document
UB92 Medicare Zevalin Form - Download as a Word or PDF document
UB92 Medicare Rituxan Form - Download as a Word or PDF document
CMS1500 Private Zevalin Form - Download as a Word or PDF document
CMS1500 Private Rituxan Form - Download as a Word or PDF document
CMS1500 Medicare Zevalin Form - Download as a Word or PDF document
CMS1500 Medicare Rituxan Form - Download as a Word or PDF document

In-111 Zevalin diagnostic NDC: 64406-0104-04
Y-90 Zevalin therapeutic NDC: 64406-0103-03


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Cell Therapeutics, Inc.

Please consult full prescribing information for Zevalin and Rituximab, including their respective Boxed WARNINGS.
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