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ONCOLOGY DRUG CODES
Oncology Drug Codes Medications Used for the Treatment of Breast Cancer The following sections include: • Associated ICD-9-CM codes used for the classification of breast cancer • Drugs that have been FDA-approved in breast cancer. 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 breast cancer. 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.
Associated ICD-9-CM Codes Used for Breast Cancer 174
Malignant neoplasm of female breast Use additional code to identify estrogen-receptor status (V86.0, V86.1) Includes: breast (female) connective tissue soft parts Paget’s disease of: breast nipple Excludes: skin of breast (172.5, 173.5) 174.0 Nipple and areola 174.1 Central portion 174.2 Upper inner quadrant 174.3 Lower inner quadrant 174.4 Upper outer quadrant 174.5 Lower outer quadrant 174.6 Axillary tail 174.8 Other specified sites of female breast Ectopic sites Inner breast Lower breast Malignant neoplasm of contiguous or overlapping sites of breast whose point of origin cannot be determined Midline of breast Outer breast Upper breast 174.9 Breast (female), unspecified
175 Malignant neoplasm of male breast Use additional code to identify estrogen-receptor status (V86.0, V86.1) Excludes: skin of breast (172.5, 173.5) 175.0 Nipple and areola 175.9 Other and unspecified sites of male breast Ectopic breast tissue, male
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FDAapproved for breast cancer
NCCN Drugs & Biologics Compendium off-label use for breast cancer
Current code price (AWP-based pricing), effective 10/1/09
Medicare allowable (ASP + 6%), effective 10/1/09-12/31/09
CPT administration codes
Generic (brand) name
HCPCS code: code description
anastrozole (Arimidex)
?
anastrozole (Arimidex)
J8999a: prescription drug, oral, chemotherapeutic, not otherwise specified S0170: anastrozole, oral, 1 mg
?
NDC level pricing $13.04
bevacizumab (Avastin) capecitabine (Xeloda) capecitabine (Xeloda) carboplatin (Paraplatin)
J9035: injection, bevacizumab, 10 mg J8520: capecitabine, oral, 150 mg J8521: capecitabine, oral, 500 mg J9045: injection, carboplatin, 50 mg
?
$68.75
NDC level pricing S0170: not payable by Medicare $57.48
?
$7.76
$5.79
N/A
?
$25.85
$19.09
N/A
$85.10
$4.60
G REEN H ILL H EALTHCARE C OMMUNICATIONS
?
N/A
N/A
96413, 96415
96409, 96413, 96415
September/October 2009