ONCOLOGY DRUG CODES
Oncology Drug Codes Medications Used for the Treatment of Genitourinary Cancers The following sections include: • Associated ICD-9-CM codes used for the classification of genitourinary cancers • Drugs that have been FDA-approved in the treatment of genitourinary cancers. Please note: if a check mark appears in the FDA column it will NOT appear in the compendia section even if a drug is included in the NCCN (National Comprehensive Cancer Network) Drugs & Biologics Compendium • Drugs included in the NCCN Drugs & Biologics Compendium for off-label use in genitourinary cancers. NCCN is recognized by the Centers for Medicare & Medicaid Services (CMS) as a referencing source • Corresponding HCPCS/CPT codes and code descriptions • Current Code Price (AWP-based pricing) • Most recent ASP plus 6% (Medicare allowable) • Possible CPT Administration Codes for each medication.
Generic (brand) name
HCPCS code: code description
altretamine (Hexalen)
J8999*: prescription drug, oral, chemotherapeutic, not otherwise specified
anastrozole (Arimidex)
J8999*: prescription drug, chemotherapeutic, oral, not otherwise specified
anastrozole (Arimidex)
Ovarian Cancer The following section will assist healthcare professionals and payers by providing appropriate coding, billing, and reimbursement information associated with the management of ovarian cancer.
Associated ICD-9-CM Codes Used for Ovarian Cancer 183 Malignant neoplasm of ovary and other uterine adnexa 183.0 Ovary 183.2 Fallopian tube Oviduct Uterine tube 183.3 Broad ligament Mesovarium Parovarian region 183.4 Parametrium Uterine ligament NOS Uterosacral ligament 183.5 Round ligament 183.8 Other specified sites of uterine adnexa Tubo-ovarian Utero-ovarian Malignant neoplasm of contiguous or overlapping sites of ovary and other uterine adnexa whose point of origin cannot be determined 183.9 Uterine adnexa, unspecified
FDAapproved for ovarian cancer
NCCN Drugs & Biologics Compendium off-label use for ovarian cancer
Current code price (AWPbased pricing)
Medicare allowable (ASP + 6%), effective 7/1/09-9/30/09
CPT administration codes
NDC level pricing
NDC level pricing
N/A
NDC level pricing
NDC level pricing
N/A
S0170: anastrozole, oral, 1 mg
$12.81
S0170: not payable by Medicare
N/A
bevacizumab (Avastin)
J9035: injection, bevacizumab, 10 mg
$68.75
$57.43
96413, 96415
bleomycin (Blenoxane)
J9040: injection, bleomycin sulfate, 15 units
$46.33
$30.89
96401, 96409
capecitabine (Xeloda)
J8520: capecitabine, oral, 150 mg
$7.35
$5.72
N/A
capecitabine (Xeloda)
J8521: capecitabine, oral, 500 mg
$24.50
$19.02
N/A
July/August 2009
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ONCOLOGY DRUG CODES 24
FDAapproved for ovarian cancer
NCCN Drugs & Biologics Compendium off-label use for ovarian cancer
Current code price (AWPbased pricing)
Medicare allowable (ASP + 6%), effective 7/1/09-9/30/09
CPT administration codes
Generic (brand) name
HCPCS code: code description
carboplatin (Paraplatin)
J9045: injection, carboplatin, 50 mg
$85.10
$5.22
96409, 96413, 96415
cisplatin (Platinol AQ)
J9060: cisplatin, powder or solution, per 10 mg
$4.51
$2.32
96409, 96413, 96415
cisplatin (Platinol AQ)
J9062: cisplatin, 50 mg
$22.56
$11.60
96409, 96413, 96415
cyclophosphamide oral (Cytoxan)
J8530: cyclophosphamide, oral, 25 mg
$2.09
$0.90
cyclophosphamide injection (Cytoxan)
J9090: cyclophosphamide, 500 mg
$31.60
$20.09
96409, 96413, 96415
cyclophosphamide injection (Cytoxan)
J9091: cyclophosphamide, 1.0 gm
$56.90
$40.18
96409, 96413, 96415
cyclophosphamide injection (Cytoxan)
J9092: cyclophosphamide, 2.0 gm
$52.50
$80.35
96409, 96413, 96415
dactinomycin (Cosmegen)
J9120: injection, dactinomycin, 0.5 mg
$654.08
$543.73
96409
docetaxel (Taxotere)
J9170: injection, docetaxel, 20 mg
$467.37
$344.65
96413
doxorubicin HCl (Adriamycin)
J9000: injection, doxorubicin hydrochloride, 10 mg
$13.75
$3.58
96409
doxorubicin HCl liposome (Doxil)
J9001: injection, doxorubicin hydrochloride all lipid formulations, 10 mg
$565.63
$456.99
96413
etoposide (Etopophos, Toposar)
J9181: injection, etoposide, 10 mg
$0.55
$0.45
96413, 96415
etoposide (VePesid)
J8560: etoposide, oral, 50 mg
$47.64
$30.35
N/A
gemcitabine (Gemzar)
J9201: injection, gemcitabine hydrochloride, 200 mg
$172.41
$141.29
hydroxyurea (Hydrea)
J8999*: prescription drug, oral, chemotherapeutic, not otherwise specified
NDC level pricing
NDC level pricing
N/A
hydroxyurea (Hydrea)
S0176: hydroxyurea, oral, 500 mg
$1.28
S0176: not payable by Medicare
N/A
ifosfamide (Ifex)
J9208: injection, ifosfamide, 1 g
$58.75
$30.03
96413, 96415
irinotecan (Camptosar)
J9206: injection, irinotecan, 20 mg
$32.82
$14.96
96413, 96415
letrozole (Femara)
J8999*: prescription drug, oral, chemotherapeutic, not otherwise specified
NDC level pricing
leuprolide (Lupron Depot)
J9217: leuprolide acetate (for depot suspension), 7.5 mg
$367.25
megestrol (Megace)
J8999*: prescription drug, oral, chemotherapeutic, not otherwise specified
NDC level pricing
NDC level pricing
N/A
megestrol (Megace)
S0179: megestrol acetate, oral 20 mg
$0.66
S0179: not payable by Medicare
N/A
melphalan oral (Alkeran oral)
J8600: melphalan, oral, 2 mg
$5.63
$4.68
N/A
G REEN H ILL H EALTHCARE C OMMUNICATIONS
NDC level pricing $198.87
N/A
96413
N/A
96402
July/August 2009
FDAapproved for ovarian cancer
Current code price (AWPbased pricing)
Medicare allowable (ASP + 6%), effective 7/1/09-9/30/09
CPT administration codes
Generic (brand) name
HCPCS code: code description
melphalan injection (Alkeran injection)
J9245: injection, melphalan hydrochloride, 50 mg
$2003.78
$1624.60
96409, 96413
oxaliplatin (Eloxatin)
J9263: injection, oxaliplatin, 0.5 mg
$12.26
$9.61
96413, 96415
paclitaxel (Taxol)
J9265: injection, paclitaxel, 30 mg
$21.25
$7.72
96413, 96415
pemetrexed (Alimta)
J9305: injection, pemetrexed, 10 mg
$60.21
$49.46
tamoxifen (Nolvadex)
J8999*: prescription drug, oral, chemotherapeutic, not otherwise specified
NDC level pricing
NDC level pricing
N/A
tamoxifen (Nolvadex)
S0187: tamoxifen citrate, oral, 10 mg
$1.89
S0187: not payable by Medicare
N/A
thiotepa (Thiotepa)
J9340: injection, thiotepa, 15 mg
$143.75
$97.35
topotecan injection (Hycamtin)
J9350: injection, topotecan, 4 mg
$1257.89
$981.08
96413
vinBLAStine
J9360: injection, vinblastine sulfate, 1 mg
$3.31
$1.01
96409
vinCRIStine (Vincasar PFS)
J9370: vincristine sulfate, 1 mg
$9.90
$5.70
96409
vinCRIStine (Vincasar PFS)
J9375: vincristine sulfate, 2 mg
$19.80
$11.40
96409
vinCRIStine (Vincasar PFS)
J9380: vincristine sulfate, 5 mg
$49.50
$28.49
96409
vinorelbine (Navelbine)
J9390: injection, vinorelbine tartrate, per 10 mg
$44.38
$13.14
96409
Prostate Cancer
96409
51720, 96409
Associated ICD-9-CM Code Used for Prostate Cancer
The following section will assist healthcare professionals and payers by providing appropriate coding, billing, and reimbursement information associated with the management of prostate cancer.
FDAapproved for prostrate cancer
185 Malignant neoplasm of prostate Excludes: seminal vesicles (187.8)
NCCN Drugs & Biologics Compendium off-label use for prostate cancer
Current code price (AWPbased pricing)
Medicare allowable (ASP + 6%), effective 7/1/09-9/30/09
CPT administration codes
Generic (brand) name
HCPCS code: code description
bicalutamide (Casodex)
J8999*: prescription drug, oral, chemotherapeutic, not otherwise specified
carboplatin (Paraplatin)
J9045: injection, carboplatin, 50 mg
$85.10
$5.22
96409, 96413, 96415
cisplatin (Platinol AQ)
J9060: cisplatin, powder or solution, per 10 mg
$4.51
$2.32
96409, 96413, 96415
cisplatin (Platinol AQ)
J9062: cisplatin, 50 mg
$22.56
$11.60
96409, 96413, 96415
Degarelix
J9999*: not otherwise classified, antineoplastic drugs OR C9399: unclassified drugs or biological
July/August 2009
ONCOLOGY DRUG CODES
NCCN Drugs & Biologics Compendium off-label use for ovarian cancer
NDC level pricing
NDC level pricing
NDC level pricing
NDC level pricing
N/A
96402
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ONCOLOGY DRUG CODES
FDAapproved for prostrate cancer
NCCN Drugs & Biologics Compendium off-label use for prostate cancer
Current code price (AWPbased pricing)
Medicare allowable (ASP + 6%), effective 7/1/09-9/30/09
CPT administration codes
Generic (brand) name
HCPCS code: code description
docetaxel (Taxotere)
J9170: injection, docetaxel, 20 mg
estradiol (Estrace)
J8499*: prescription drug, oral, nonchemotherapeutic, not otherwise specified
NDC level pricing
NDC level pricing
N/A
estramustine (Emcyt)
J8999*: prescription drug, oral, chemotherapeutic, not otherwise specified
NDC level pricing
NDC level pricing
N/A
etoposide (Etopophos)
J9181: injection, etoposide, 10 mg
$0.55
$0.45
96413, 96415
etoposide (VePesid)
J8560: etoposide, oral, 50 mg
$47.64
$30.35
N/A
flutamide (Eulexin)
J8999*: prescription drug, oral, chemotherapeutic, not otherwise specified
NDC level pricing
goserelin (Zoladex)
J9202: goserelin acetate implant, per 3.6 mg
$469.99
$196.05
histrelin (Vantas)
J9225: histrelin implant (Vantas), 50 mg
$6250.00
$1579.32
ketoconazole (Nizoral)
J8499*: prescription drug, oral, nonchemotherapeutic, not otherwise specified
leuprolide (Lupron Depot, Eligard)
J9217: leuprolide acetate (for depot suspension), 7.5 mg
$367.25
$198.87
mitoxantrone (Novantrone)
J9293: injection, mitoxantrone hydrochloride, per 5 mg
$126.94
$68.36
nilutamide (Nilandron)
J8999*: prescription drug, oral, chemotherapeutic, not otherwise specified
NDC level pricing
prednisone
J7506: prednisone, oral, per 5 mg
triptorelin (Trelstar LA, Trelstar Depot)
J3315: injection, triptorelin pamoate, 3.75 mg
zoledronic acid (Zometa)
J3487: injection (Zometa), zoledronic acid, 1 mg
$467.37
NDC level pricing
$344.65
NDC level pricing
96413
N/A
NDC level pricing
96372, 96402 11981, 11982, 11983 N/A
NDC level pricing
96402
96409, 96413 N/A
$0.05
$0.04
N/A
$756.25
$161.82
96372, 96402
$268.96
$217.37
96365, 96374
*When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (ie, J8999 for Tamoxifen) in column 24D and the drug name, strength, and National Drug Code (NDC) in box 19 to ensure appropriate reimbursement. References • HCPCS Level II Expert, 2009 • CPT 2009; 2008 • ICD-9-CM for Professionals Volumes 1 & 2; 2009 • The Drug Reimbursement Coding and Pricing Guide, Vol 6, No 3; RJ Health Systems International LLC; 3rd Quarter 2009 • FDA-approved indication (from products' prescribing information) • NCCN • National Cancer Institute • www.ReimbursementCodes.com powered by RJ Health Systems International, LLC., Wethersfield, Connecticut • CMS-Medicare allowable 3rd Quarter 2009 (effective dates 7/1/09-9/30/09). Prices listed herein are effective as of July 1, 2009. 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; NCCN, National Comprehensive Cancer Network.
This information was supplied by:
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www.jomcc.com July/August 2009