ONCOLOGY DRUG CODES Supplied by: RJ Health Systems
Medications Used for the Treatment of Lymphomas The following sections include: • Associated ICD-9-CM codes used for the classification of lymphomas • Drugs that have been FDA-approved in the treatment of lymphomas. 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 lymphomas. 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
18
generic (Brand) name
HCPCS code: code description
alemtuzumab (Campath) asparaginase (Elspar) bendamustine (Treanda) betamethasone (Celestone Soluspan)
J9010: injection, alemtuzumab, 10 mg J9020: injection, asparaginase, 10,000 units J9033: injection, bendamustine HCl, 1 mg J0702: injection, betamethasone acetate, 3 mg and betamethasone sodium phosphate, 3 mg
APRIL 2010 I VOL 3, NO 2
Associated ICD-9-CM Codes Used for Lymphomas The following fifth-digit subclassification is for use with categories 200-202: 0 unspecified site, extranodal and solid organ sites 1 lymph nodes of head, face, and neck 2 intrathoracic lymph nodes 3 intra-abdominal lymph nodes 4 lymph nodes of axilla and upper limb 5 lymph nodes of inguinal region and lower limb 6 intrapelvic lymph nodes 7 spleen 8 lymph nodes of multiple sites 200 Lymphosarcoma and reticulosarcoma and other specified malignant tumors of lymphatic tissue 200.0 Reticulosarcoma 200.1 Lymphosarcoma 200.2 Burkitt’s tumor or lymphoma 200.3 Marginal zone lymphoma 200.4 Mantle cell lymphoma 200.5 Primary central nervous system lymphoma 200.6 Anaplastic large cell lymphoma 200.7 Large cell lymphoma 200.8 Other named variants Lymphoma (malignant): lymphoplasmacytoid type mixed lymphocytic-histiocytic (diffuse) Lymphosarcoma, mixed cell type (diffuse) Reticulolymphosarcoma (diffuse) 202 Other malignant neoplasms of lymphoid and histiocytic tissue 202.0 Nodular lymphoma 202.1 Mycosis fungoides 202.2 Sézary’s disease 202.3 Malignant histiocytosis 202.4 Leukemic reticuloendotheliosis 202.5 Letterer-Siwe disease 202.6 Malignant mast cell tumors 202.7 Peripheral T-cell lymphoma 202.8 Other lymphomas Lymphoma (malignant): not otherwise specified diffuse Excludes: benign lymphoma (229.0) 202.9 Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue Follicular dendritic cell sarcoma Interdigitating dendritic cell sarcoma Langerhans cell sarcoma Malignant neoplasm of bone marrow not otherwise specified
FDAapproved for lymphomas
NCCN Drugs & Biologics Compendium off-label use for lymphomas
Current code price (AWP-based pricing), effective 4/1/10
Medicare allowable (ASP + 6%), effective 4/1/10-6/30/10
CPT administration codes
$680.73
$578.01
96413, 96415
$70.42
$60.94
96401, 96413
$21.60
$18.47
96413
$6.85
$6.55
11900, 11901, 20600, 20605, 20610, 96372
www.JOMCC.com
ONCOLOGY DRUG CODES Supplied by: RJ Health Systems
FDAapproved for lymphomas
generic (Brand) name
HCPCS code: code description
bexarotene (Targretin)
J8999a: prescription drug, oral, chemotherapeutic, not otherwise specified J9040: injection, bleomycin sulfate, 15 units J9041: injection, bortezomib, 0.1 mg J9045: injection, carboplatin, 50 mg J9050: injection, carmustine, 100 mg J8999a: prescription drug, oral, chemotherapeutic, not otherwise specified J9060: cisplatin, powder or solution, per 10 mg J9062: cisplatin, 50 mg J9065: injection, cladribine, per 1 mg J8530: cyclophosphamide, oral, 25 mg
bleomycin (Blenoxane) bortezomib (Velcade) carboplatin (Paraplatin) carmustine (BiCNU) chlorambucil (Leukeran) cisplatin (Platinol-AQ) cisplatin (Platinol-AQ) cladribine (Leustatin) cyclophosphamide, oral (Cytoxan) cyclophosphamide, injection (Cytoxan) cyclophosphamide, injection (Cytoxan) cyclophosphamide, injection (Cytoxan) cyclophosphamide, injection (Cytoxan) cyclophosphamide, injection (Cytoxan) cytarabine (Cytosar-U) dacarbazine (DTIC-Dome) daunorubicin (Cerubidine) denileukin diftitox (Ontak) dexamethasone (Decadron) dexamethasone (Decadron) doxorubicin HCl (Adriamycin)
www.JOMCC.com
NCCN Drugs & Biologics Compendium off-label use for lymphomas
Current code price (AWP-based pricing), effective 4/1/10
Medicare allowable (ASP + 6%), effective 4/1/10-6/30/10
CPT administration codes
NDC level pricing $45.30
NDC level pricing $26.08
96401, 96409
$45.43
$38.24
96409
$48.55
$5.31
$205.69
$176.41
NDC level pricing $4.33
NDC level pricing $1.98
96409, 96413, 96415
$21.66
$9.91
96409, 96413, 96415
$58.20
$28.22
$2.09
$0.84
J9070: cyclophosphamide, 100 mg
$7.55
$4.35
96409, 96413, 96419
J9080: cyclophosphamide, 200 mg
$15.10
$8.69
96409, 96413, 96415
J9090: cyclophosphamide, 500 mg
$37.76
$21.73
96409, 96413, 96415
J9091: cyclophosphamide, 1.0 gram
$68.00
$43.46
96409, 96413, 96415
J9092: cyclophosphamide, 2.0 grams
$122.39
$86.92
96409, 96413, 96415
$2.31
$1.51
$22.21
$7.37
96409, 96413, 96415, 96450 96409, 96413
$25.20
$19.46
96409, 96413
$1,756.80
$1,494.82
96409, 96413, 96415
$0.15
$0.09
$0.09
$0.38
11900, 11901, 20600, 20605, 20610, 96372, 96374 N/A
$13.20
$3.04
96409
J9100: injection, cytarabine, 100 mg J9140: dacarbazine, 200 mg J9150: injection, daunorubicin, 10 mg J9160: injection, denileukin diftitox, 300 micrograms J1100: injection, dexamethasone sodium phosphate, 1 mg J8540: dexamethasone, oral, 0.25 mg J9000: injection, doxorubicin hydrochloride, 10 mg
N/A
96409, 96413, 96415 96413, 96415 N/A
96413, 96415 N/A
APRIL 2010 I VOL 3, NO 2
19
ONCOLOGY DRUG CODES Supplied by: RJ Health Systems
generic (Brand) name
HCPCS code: code description
FDAapproved for lymphomas
doxorubicin liposome J9001: injection, doxorubicin (Doxil) hydrochloride, all lipid formulations, 10 mg etoposide J9181: injection, (Etopophos, Toposar) etoposide, 10 mg etoposide J8560: etoposide, (Vepesid) oral, 50 mg fludarabine J9185: injection, fludarabine phosphate phosphate, 50 mg (Fludara) gemcitabine J9201: injection, gemcitabine (Gemzar) hydrochloride, 200 mg hydrocortisone J1720: injection, hydrocortisone (Solu-Cortef) sodium succinate, up to 100 mg ibritumomab A9542: indium In-111 tiuxetan ibritumomab tiuxetan, diagnostic, (Zevalin) per study dose, up to 5 millicuries ibritumomab A9543: yttrium Y-90 ibritumomab tiuxetan tiuxetan, therapeutic, per (Zevalin) treatment dose, up to 40 millicuries ifosfamide J9208: injection, (Ifex) ifosfamide, 1 gram interferon J9214: injection, interferon, alfa-2b alfa-2b, recombinant, (Intron-A) 1 million units interferon gamma 1-b J9216: injection, interferon, (Actimmune) gamma 1-b, 3 million units isotretinoin J8499a: prescription drug, (Accutane) oral, non-chemotherapeutic, not otherwise specified lenalidomide J8999a: prescription drug, (Revlimid) oral, chemotherapeutic, not otherwise specified lomustine J8999a: prescription drug, (CeeNU) oral, chemotherapeutic, not otherwise specified lomustine S0178: lomustine, (CeeNu) oral, 10 mg mechlorethamine (Mustargen) melphalan (Alkeran) melphalan (Alkeran) mesna (Mesnex) mesna (Mesnex) methotrexate
J9230: injection, mechlorethamine hydrochloride (nitrogen mustard), 10 mg J8600: melphalan, oral, 2 mg J9245: injection, melphalan hydrochloride, 50 mg J8999a: prescription drug, oral, chemotherapeutic, not otherwise specified J9209: injection, mesna, 200 mg J8610: methotrexate, oral, 2.5 mg
NCCN Drugs & Biologics Compendium off-label use for lymphomas
Current code price (AWP-based pricing), effective 4/1/10
Medicare allowable (ASP + 6%), effective 4/1/10-6/30/10
CPT administration codes
$578.88
$472.01
96413
$0.53
$0.49
$47.64
$28.26
N/A
$309.70
$205.81
96413
$173.83
$145.10
96413
$2.46
$3.14
$4,200.00
N/A
96365, 96366, 96372, 96374 96374
$37,800.00
N/A
79403
96413, 96415
$56.40
$30.76
96413, 96415
$21.90
$15.84
96372, 96401
$517.89
$430.93
NDC level pricing NDC level pricing NDC level pricing $10.59
$178.71
NDC level pricing NDC level pricing NDC level pricing S0178: not payable by Medicare $154.50
N/A
96409
N/A
N/A
N/A
N/A
$5.68
$4.83
$1,922.50
$1,500.32
NDC level pricing $10.44
NDC level pricing $4.26
96409
$3.61
$0.16
N/A
96372
96409, 96413 N/A
Continued on page 22
20
APRIL 2010 I VOL 3, NO 2
www.JOMCC.com