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Billing and Coding for Avastin® (bevacizumab)

 

 

These tables are provided for informational purposes only. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantees concerning reimbursement or coverage for any service or item.

 

 

Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding for single-use vials and wastage. Many payers will not accept unspecified codes. Practices who use unspecified codes should check with their payers.

 

  •   First- and Second-Line Metastatic Colorectal Cancer
    Type  CodeDescription
    Select Diagnosis: ICD-9-CM* 153.0–153.9 Malignant neoplasm of colon
    154.0 Malignant neoplasm of rectosigmoid junction
    154.1 Malignant neoplasm of rectum
    154.8 Malignant neoplasm of other sites of rectum, rectosigmoid junction, and anus
    Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

  •   First-Line Non-Small Cell Lung Cancer
    Type  CodeDESCRIPTION
    Select Diagnosis: ICD-9-CM* 162.2-162.9 Malignant neoplasm of bronchus and lung
    Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

  •   Metastatic Renal Cell Carcinoma
    Type  CodeDESCRIPTION
    Select Diagnosis:
    ICD-9-CM*
    189.0 Malignant neoplasm of kidney, except pelvis
    Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures, and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

  •   Glioblastoma With Progressive Disease
    Type  CodeDESCRIPTION
    Select Diagnosis:
    ICD-9-CM*
    191.0–191.9 Malignant neoplasm of brain
    Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

  •  Persistent, Recurrent, or Metastatic Cervical Cancer
    Type  CodeDescription
    Select Diagnosis: ICD-9-CM* 180.0 Malignant neoplasm of the endocervix
    180.1 Malignant neoplasm of the exocervix
    180.8 (malignant neoplasm of other specified sites of cervix)
    180.9 (malignant neoplasm of the cervix uteri, unspecified site)
    Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

  •  Platinum-resistant, Recurrent, Epithelial Ovarian, Fallopian tube, or Primary Peritoneal Cancer
    Type  CodeDescription
    Select Diagnosis: ICD-9-CM* 183.0 malignant neoplasm of ovary
    183.2 malignant neoplasm of fallopian tube
    158.8 Malignant neoplasm; specified parts of peritoneum
    Culdesac (of Douglas), Mesentery, Mesocolon, Omentum, Peritoneum: parietal, pelvic Rectouterine pouch, Malignant neoplasm of contiguous or overlapping sites of retroperitoneum and peritoneum whose point of origin cannot be determined
    158.9 Malignant neoplasm; peritoneum, unspecified
    Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

Upcoming ICD-10 Transition

Implementation of the International Classification of Diseases—10th Revision—Clinical Modification (ICD-10-CM) code set is scheduled to take effect on October 1, 2015. It is recommended that practices begin preparing for the transition as soon as possible to ensure your patients face no interruptions in their treatment.

 

Use the following resources to help you plan for the changeover.

 

For coding information, please visit http://www.aapc.com/icd-10/naming-conventions.aspx.

 

For general information about the ICD-10 transition, please visit
http://cms.gov/Medicare/Coding/ICD10/ProviderResources.html or http://www.ahima.org/icd10/.

 

To receive an ICD-9 to ICD-10 Mapping Guide, please contact your Genentech Representative. If you do not know who your Genentech Representative is, please call Customer Service at 800-551-2231

 

For a checklist to prepare for the transition, please click here

 

Billing and Coding for Avastin® (bevacizumab)

 

These tables are provided for informational purposes only. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantees concerning reimbursement or coverage for any service or item.

 

Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding for single-use vials and wastage. Many payers will not accept unspecified codes. Practices who use unspecified codes should check with their payers.

 

  •   First- and Second-Line Metastatic Colorectal Cancer
    Type  CodeDescription
    Diagnosis: ICD-10-CM C18.0 Malignant neoplasm of the cecum
    C18.2-C18.9 Malignant neoplasm of the colon, various sites
    C19 Malignant neoplasm of rectosigmoid junction
    C20 Malignant neoplasm of rectum, rectal ampulla
    C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
    Drug: HCPCS    
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

  •   First-Line Non-Small Cell Lung Cancer
    Type  CodeDESCRIPTION
    Diagnosis: ICD-10-CM C34.00–C34.02 Malignant neoplasm of bronchus and lung; main bronchus
    C34.10–C34.12 Malignant neoplasm of bronchus and lung; upper lobe
    C34.2 Malignant neoplasm of bronchus and lung; middle lobe
    C34.30–C34.32 Malignant neoplasm of bronchus and lung; lower lobe 
    C34.80–C34.82 Malignant neoplasm of bronchus and lung; overlapping sites
    C34.90–C34.92 Malignant neoplasm of bronchus and lung; unspecified part
    Drug: HCPCS JP9035 Injection, bevacizumab, 10 mg
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

  •   Metastatic Renal Cell Carcinoma
    Type  CodeDESCRIPTION
    Diagnosis: ICD-10-CM C64.1–C64.2 Malignant neoplasm of right and left kidney, except renal pelvis
    C64.9 Malignant neoplasm of unspecified kidney, except renal pelvis
    Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures, and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

  •   Glioblastoma With Progressive Disease
    Type  CodeDESCRIPTION
    Diagnosis: ICD-10-CM C71.0–C71.9 Malignant neoplasm of the brain
    Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

  •  Persistent, Recurrent, or Metastatic Cervical Cancer
    Type  CodeDescription
    Diagnosis: ICD-10-CM C53.0–C53.1 Malignant neoplasm of the endocervix and exocervix
    C53.8–C53.9 Malignant neoplasm of overlapping sites of cervix uteri and unspecified sites of the cervix uteri
    Drug: HCPCS JP9035 Injection, bevacizumab, 10 mg 
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

  •  Platinum-resistant, Recurrent, Epithelial Ovarian, Fallopian tube, or Primary Peritoneal Cancer
    Type  CodeDescription
    Diagnosis: ICD-10-CM C56.1–C56.2 Malignant neoplasm of the right and left ovary
    C56.9 Malignant neoplasm of unspecified ovary
    C57.00–C57.02 Malignant neoplasm of the right and left fallopian tube(s) and unspecified
    C48.1–C48.2 Malignant neoplasm of specified parts of peritoneum and unspecified
    C48.8 Malignant neoplasm of overlapping sitesof retroperitoneum and peritoneum
    Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
    NDC‡§ 10-digit 11-digit  
    50242-060-01 50242-0060-01 100 mg/4 mL single-use vial
    50242-061-01 50242-0061-01 400 mg/16 mL single-use vial
    Select Services, Procedures and Supplies: CPT®|| 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
    96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
    96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

     

    * International Classification of Diseases, 9th Revision, Clinical Modification.
    Healthcare Common Procedure Coding System.
    National Drug Code.
    § Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference. Avastin Access Solutions provides this information when we perform a benefits investigation (BI) for your patient.
    || Current Procedural Terminology.

     

*International Classification of Diseases, 10th Revision, Clinical Modification.

NEXT TOPICAppeals 

Appeals

If your office has prescribed Avastin® (bevacizumab), but your patient’s insurer has denied coverage, you can appeal that decision. Avastin Access Solutions might be able to help you as you resolve the situation. Here is what you can do*:

 

  1. Understand why the request or claim has been denied. This should be in the insurer’s letter of denial or the patient’s Explanation of Benefits (EOB) letter.
  2. Contact Avastin Access Solutions for guidance as you put together an appeal. Use these resources to help you gather the documents and information you need for a successful appeal.
  3. Complete and submit the required forms and documents to the insurer before the appeal deadline. Avastin Access Solutions can provide information about this process.
Below are some helpful files for handling common issues in denials. Download will occur automatically on selection.

  

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