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ONCOLOGY DRUG CODES Supplied by: RJ Health Systems Continued from page 19
generic (Brand) name
HCPCS code: code description
pemetrexed (Alimta) porfimer sodium (Photofrin) procarbazine (Matulane)
J9305: injection, pemetrexed, 10 mg J9600: injection, porfimer sodium, 75 mg J8999b: prescription drug, oral, chemotherapeutic, not otherwise specified S0182: procarbazine HCl, oral, 50 mg
procarbazine (Matulane) tamoxifen (Nolvadex) tamoxifen (Nolvadex) teniposide (Vumon) topotecan (Hycamtin) topotecan (Hycamtin) trastuzumab (Herceptin) vinBLAStine vinCRIStine (Vincasar) vinCRIStine (Vincasar) vinCRIStine (Vincasar) vinorelbine tartrate (Navelbine) a
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
✓
$60.67
$50.63
96409
✓
$3,317.04
$2,934.28
96409
✓
N/A
J8999b: prescription drug, oral, chemotherapeutic, not otherwise specified S0187: tamoxifen citrate, oral, 10 mg
✓
✓
NDC level pricing $1.89
Q2017: injection, teniposide, 50 mg J8705: topotecan, oral, 0.25 mg J9350: injection topotecan, 4 mg J9355: injection, trastuzumab, 10 mg J9360: injection, vinblastine sulfate, 1 mg J9370: vincristine sulfate, 1 mg J9375: vincristine sulfate, 2 mg J9380: vincristine sulfate, 5 mg J9390: injection, vinorelbine tartrate, per 10 mg
✓
$376.55
NDC level pricing S0182 not payable by Medicare NDC level pricing S0187 not payable by Medicare $324.55
✓
$89.73
$74.66
N/A
✓
$1,306.10
$1,058.90
96413
✓
$78.26
$66.42
✓
$3.18
$1.02
96409
✓
$7.22
$4.31
96409
✓
$14.44
$8.62
96409
✓
$36.10
$21.54
96409
$42.60
$10.05
96409
✓
✓
NDC level pricing $55.68
N/A
N/A
N/A
96413, 96415
96413, 96415
Compendia references available upon request.
When billing a non-classified medication using a CMS 1500 claim form you must include both the HCPCS code (ie, J8999 for Tarceva) in Column 24D and the drug name, strength, and National Drug Code (NDC) in Box 19 in order to ensure appropriate reimbursement.
b
References HCPCS Level II Expert 2010 • Current Procedural Terminology (CPT) 2010 • ICD-9-CM for Professionals Volumes 1 & 2 2010 • The Drug Reimbursement Coding and Pricing Guide by RJ Health Systems International, LLC, Volume 7, Number 2, 2nd Quarter 2010 • FDA-approved indication (from product’s prescribing information) • National Cancer Institute® • www.ReimbursementCodes.com powered by RJ Health Systems International, LLC, Wethersfield, Connecticut • CMS (Centers for Medicare and Medicaid Services)—Medicare Allowable 2nd Quarter 2010 (effective dates 4/1/106/30/10). Prices listed herein are effective as of June 1, 2010. ASP indicates average sales price; AWP, average wholesale price; CMS, Centers for Medicare & Medicaid Services; CPT, Current Procedural Terminology; FDA, US Food and Drug Administration; HCPCS, Healthcare Common Procedure Coding System; NDC, National Drug Code.
This information was supplied by:
PO BOX 290616, Wethersfield, CT 06109 T: (860) 563-1223 • F: (860) 563-1650 www.RJHealthSystems.com
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June 2010 I VOL 3, nO 4
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