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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.

 

  •   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
    Hospital Outpatient: HCPCS C9257 Injection, bevacizumab, 0.25 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
    Hospital Outpatient: HCPCS C9257 Injection, bevacizumab, 0.25 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
    Hospital Outpatient: HCPCS  C9257 Injection, bevacizumab, 0.25 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
    Hospital Outpatient: HCPCS C9257 Injection, bevacizumab, 0.25 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.

     

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.

 

* This description of the appeals process is for informational purposes only. The submission of an appeal is the responsibility of the patient and your office. Avastin Access Solutions makes no representation or guarantee concerning reimbursement or coverage for any service or item. Each health insurer and patient case may require different information. Please review each denial and the health insurer’s guidelines to determine what to include in your patient’s appeal package.
Learn More About
Avastin
  • LEARN about treatment with Avastin
  • LEARN HOW the Genentech BioOncology Co-pay Card can help with the out-of-pocket costs for Avastin
  • Download: new forms for enrollment in GATCF
  • Form Statement of Medical Necessity
  • Form Patient Authorization and Notice of Release of Information

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