TOP_December 2010_FINAL_TOP 11/17/10 1:06 PM Page 18
ONCOLOGY DRUG CODES Supplied by: RJ Health Systems
Medications Used for the Treatment of Hematologic Cancers The following sections will assist healthcare professionals and payers by providing appropriate coding, billing, and reimbursement information associated with the management of multiple myeloma or myelodysplastic syndromes.
Multiple Myeloma Multiple myeloma is a type of cancer that begins in plasma cells (white blood cells that produce antibodies).
The following sections include: • Associated ICD-9-CM codes used for the classification of multiple myeloma or myelodysplastic syndromes • Drugs that have been FDA-approved in the treatment of multiple myeloma or myelodysplastic syndromes • Drugs that are Compendia listed for off-label use for breast cancer based on clinical studies that suggest beneficial use in some cases. Please note: if a check mark appears in the FDA column it will NOT appear in the compendia off-label use column • Corresponding HCPCS/CPT® codes and code descriptions • Current Code Price (AWP-based pricing) • Most recent ASP plus 6% (Medicare allowable), if applicable • Possible CPT® Administration Codes for each medication
generic (Brand) name
HCPCS code: code description
J9017: injection, arsenic trioxide, 1 mg J8499b: prescription drug, oral, non-chemotherapeutic, not otherwise specified betamethasone J0702: injection, acetate and betamethasone acetate betamethasone 3 mg, and sodium phosphate betamethasone sodium (Celestone Soluspan) phosphate 3 mg bortezomib J9041: injection, (Velcade) bortezomib, 0.1 mg carmustine J9050: injection, (BiCNU) carmustine, 100 mg cisplatin J9060: cisplatin, powder (Platinol AQ) or solution, per 10 mg cisplatin J9062: cisplatin, (Platinol AQ) 50 mg cortisone acetate J8499b: prescription drug, (Cortone) oral, non-chemotherapeutic, not otherwise specified cyclophosphamide J8530: cyclophosphamide, (Cytoxan) oral, 25 mg cyclophosphamide J9070: cyclophosphamide, (Cytoxan) 100 mg (all 100-mg NDCs inactive; 500-mg NDCs used to calculate code price)
Associated ICD-9-CM Codes Used for Multiple Myeloma 203 Multiple myeloma and immunoproliferative neoplasms The following fifth-digit subclassification is for use with category 203: 0 without mention of having achieved remission >Failed remission< 1 in remission 2 in relapse 203.0 Multiple myeloma Kahler’s disease Myelomatosis excludes: solitary myeloma (238.6) 203.1 Plasma cell leukemia Plasmacytic leukemia 203.8 Other immunoproliferative neoplasms
FDAapproved for multiple myeloma
arsenic trioxide (Trisenox) betamethasone (Celestone)
18
December 2010 I VOL 3, NO 8
Compendia listed off-label use for multiple myelomaa
Current code price (AWP-based pricing), effective 11/1/10
Medicare allowable (ASP + 6%), effective 10/1/10-12/31/10
CPT ® administration codes
✓
$47.51
$37.25
✓
NDC level pricing $8.00
NDC level pricing $6.24
✓
$46.66
$39.29
✓
$205.69
$175.88
✓
$4.33
$1.50
96409, 96413, 96415
✓
$21.66
$7.49
96409, 96413, 96415
✓
✓
NDC level pricing $2.09
NDC level pricing $0.83
✓
$10.57
$5.96
✓
96413, 96415 N/A
11900, 11901, 20600, 20605, 20610, 96372
96409 96413, 96415
N/A
N/A 96409, 96413, 96415
www.TheOncologyPharmacist.com