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ONCOLOGY DRUG CODES Supplied by: RJ Health Systems Associated ICD-9-CM Codes Used for Myelodysplastic Syndromes
Myelodysplastic Syndromes Myelodysplastic syndromes are a group of diseases in which the bone marrow does not make enough healthy blood cells.
generic (Brand) name
HCPCS code: code description
amifostine (Ethyol) arsenic trioxide (Trisenox) azacitidine (Vidaza) clofarabine (Clolar) cytarabine (Cytosar-U) cytarabine (Cytosar-U) darbepoetin alfa (Aranesp)
J0207: injection, amifostine, 500 mg J9017: injection, arsenic trioxide, 1 mg J9025: injection, azacitidine, 1 mg J9027: injection, clofarabine, 1 mg J9100: injection, cytarabine, 100 mg J9110: injection, cytarabine, 500 mg J0881: injection, darbepoetin alfa, 1 microgram (non-ESRD use) J0882: injection, darbepoetin alfa, 1 microgram (for ESRD on dialysis) J0894: injection, decitabine, 1 mg J0885: injection, epoetin alfa (for non-ESRD use), 1000 units J0886: injection, epoetin alfa 1000 units (for ESRD on dialysis; renal dialysis facilities and hospitals must use code Q4081, effective 1/1/07) Q4081: injection, epoetin alfa, 100 units (for ESRD on dialysis; for renal dialysis facilities and hospital use)
darbepoetin alfa (Aranesp) decitabine (Dacogen) epoetin alfa (Procrit, Epogen) epoetin alfa (Procrit, Epogen)
epoetin alfa (Procrit, Epogen)
238 Neoplasm of uncertain behavior of other and unspecified sites and tissues 238.7 Other lymphatic and hematopoietic tissues excludes: acute myelogenous leukemia (205.0) chronic myelomonocytic leukemia (205.1) myelosclerosis, not otherwise specified (289.89) myelosis: not otherwise specified (205.9) megakaryocytic (207.2) 238.72 Low-grade myelodysplastic syndrome lesions Refractory anemia (RA) Refractory anemia with ringed sideroblasts (RARS) Refractory cytopenia with multilineage dysplasia (RCMD) Refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD-RS) 238.73 High-grade myelodysplastic syndrome lesions Refractory anemia with excess blasts-1 (RAEB-1) Refractory anemia with excess blasts-2 (RAEB-2) 238.74 Myelodysplastic syndrome with 5q deletion 5q minus syndrome, not otherwise specified excludes: constitutional 5q deletion (758.39) high-grade myelodysplastic syndrome with 5q deletion (238.73) 238.75 Myelodysplastic syndrome, unspecified
FDAapproved for myelodysplastic syndromes
Compendia listed off-label use for myelodysplastic syndromesa
Current code price (AWP-based pricing), effective 11/1/10
Medicare allowable (ASP + 6%), effective 10/1/10-12/31/10
CPT ® administration codes
✓
$564.95
$318.66
✓
$47.51
$37.25
$6.03
$5.13
✓
$135.00
$115.41
✓
$1.25
$1.98
✓
$10.20
$3.67
✓
$6.44
$2.90
96409, 96413, 96415, 96450 96409, 96413, 96415, 96450 96372, 96374
✓
$6.44
$2.90
96372, 96374
$35.50
$30.74
96413, 96415
✓
$15.34
$9.68
96372, 96374
✓
$15.34
$9.68
96372, 96374
✓
$1.53
$0.97
96372, 96374
✓
✓
96374 96413, 96415 96401, 96409, 96413 96413, 96415
Continued on page 22 www.TheOncologyPharmacist.com
December 2010 I VOL 3, NO 8
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