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ONCOLOGY DRUG CODES Supplied by: RJ Health Systems
Medications Used for the Treatment of Lung Cancer Lung cancer forms in tissues of the lung, usually in the cells lining the air passages. The two main types are small-cell lung cancer and non– small-cell lung cancer. The following section will assist healthcare professionals and payers by providing appropriate coding, billing, and reimbursement information associated with the management of lung cancer. The following sections include: • Associated ICD-9-CM codes used for the classification of lung cancer • Drugs that have been FDA-approved in the treatment of lung cancer • Drugs that are compendia listed for off-label use for lung 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
amifostine (Ethyol) bevacizumab (Avastin) carboplatin (Paraplatin) cetuximab (Erbitux) cisplatin (Platinol AQ) cisplatin (Platinol AQ) cyclophosphamide (Cytoxan) cyclophosphamide (Cytoxan)
J0207: injection, amifostine, 500mg J9035: injection, bevacizumab, 10 mg J9045: injection, carboplatin, 50 mg J9055: injection, cetuximab, 10 mg J9060: cisplatin, powder or solution, per 10 mg J9062: cisplatin, 50 mg
cyclophosphamide (Cytoxan)
cyclophosphamide (Cytoxan)
18
J8530: cyclophosphamide, oral, 25 mg J9070: cyclophosphamide, 100 mg (All 100 mg NDCs inactive—500 mg NDCs used to calculate code price) J9080: cyclophosphamide, 200 mg (All 200 mg NDCs inactive—500 mg NDCs used to calculate code price) J9090: cyclophosphamide, 500 mg
June 2010 I VOL 3, nO 4
Associated ICD-9-CM Codes Used for Lung Cancer 162 Malignant neoplasm of trachea, bronchus, and lung 162.0 Trachea Cartilage of trachea Mucosa of trachea 162.2 Main bronchus Carina Hilus of lung 162.3 Upper lobe, bronchus or lung 162.4 Middle lobe, bronchus or lung 162.5 Lower lobe, bronchus or lung 162.8 Other parts of bronchus or lung Malignant neoplasm of contiguous or overlapping sites of bronchus or lung whose point of origin cannot be determined 162.9 Bronchus and lung, unspecified
FDAapproved for lung cancer
Compendia listed off-label use for lung cancera
✓
Current code price (AWP-based pricing), effective 6/1/10
Medicare allowable (ASP + 6%), effective 4/1/10-6/30/10
CPT administration codes
$564.95
$327.96
$66.99
$57.57
✓
$48.55
$5.31
✓
$57.60
$49.73
✓
$4.33
$1.98
96409, 96413, 96415
✓
$21.66
$9.91
96409, 96413, 96415
✓
$2.09
$0.84
✓
$10.57
$4.35
96409, 96413, 96415
✓
$21.15
$8.69
96409, 96413, 96415
✓
$52.87
$21.73
96409, 96413, 96415
✓
96374 96413, 96415 96409, 96413, 96415 96413, 96415
N/A
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