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ONCOLOGY DRUG CODES Supplied by: RJ Health Systems

generic (Brand) name

HCPCS code: code description

paclitaxel (Taxol) paclitaxel protein-bound particles (Abraxane) pemetrexed (Alimta) prednisone

J9265: injection, paclitaxel, 30 mg J9264: injection, paclitaxel protein-bound particles, 1 mg J9305: injection, pemetrexed, 10 mg J7506: prednisone, oral, per 5 mg J8999b: prescription drug, oral, chemotherapeutic, not otherwise specified S0187: tamoxifen citrate, oral, 10 mg

tamoxifen (Nolvadex) tamoxifen (Nolvadex) testolactone (Teslac) thiotepa (Thiotepa) toremifene citrate (Fareston) trastuzumab (Herceptin) triptorelin (Trelstar Depot, Trelstar LA) topotecan (Hycamtin) topotecan (Hycamtin) vinBLAStine vinCRIStine (Vincasar) vinCRIStine (Vincasar) vinCRIStine (Vincasar) vinorelbine (Navelbine)

J8999b: prescription drug, oral, chemotherapeutic, not otherwise specified J9340: injection, thiotepa, 15 mg J8999b: prescription drug, oral, chemotherapeutic, not otherwise specified J9355: injection, trastuzumab, 10 mg J3315: injection, triptorelin pamoate, 3.75 mg J8705: topotecan, oral, 0.25 mg J9350: injection topotecan, 4 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

FDAapproved for breast cancer

Compendia listed off-label use for breast cancera

Current code price (AWP-based pricing), effective 10/1/10

Medicare allowable (ASP + 6%), effective 10/1/10-12/31/10

CPT ® administration codes

$15.54

$7.45

96413, 96415

$11.20

$9.38

96413

$61.65

$51.44

96409

$0.04

$0.04

N/A

NDC level pricing $1.89

N/A

NDC level pricing $138.00

NDC level pricing S0187: not payable by Medicare NDC level pricing $114.09

NDC level pricing $78.26

NDC level pricing $68.28

96413, 96415

$870.00

$181.93

96372, 96402

$89.73

$77.10

N/A

$1,306.10

$1,090.84

96413

$3.18

$1.64

96409

$5.83

$3.98

96409

$11.66

$7.96

96409

$29.15

$19.90

96409

$42.60

$11.05

96409

N/A

N/A

51720, 96409 N/A

a

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 Nolvadex) 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 (CPT © copyright 2010 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association) • ICD-9-CM for Professionals Volumes 1 and 2, 2010 • The Drug Reimbursement Coding and Pricing Guide by RJ Health Systems International, LLC, Volume 7, Number 4, 4th Quarter 2010 • FDA-approved indication (from the product’s prescribing information) • National Cancer Institute® • www.ReimbursementCodes.com powered by RJ Health Systems International, LLC, Wethersfield, Connecticut • CMS (Centers for Medicare & Medicaid Services), Medicare Allowable 4th Quarter 2010 (effective dates 10/1/10-12/31/10). Prices listed herein are effective as of October 1, 2010.

www.TheOncologyPharmacist.com

OcTOber 2010 I VOL 3, NO 7

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Profile for The Oncology Pharmacist

OCTOBER 2010, VOL. 3, NO. 7  

THE ONCOLOGY PHARMACIST

OCTOBER 2010, VOL. 3, NO. 7  

THE ONCOLOGY PHARMACIST

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