This table is 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.
|174.0 – 174.9||Malignant neoplasm of female breast|
|175.0, 175.9||Malignant neoplasm of male breast|
|Drug: HCPCS†||J9306||Injection, pertuzumab, 1 mg|
|50242-145-01||50242-0145-01||420 mg/14 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. PERJETA 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
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
These codes will be 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.
|*International Classification of Diseases, 10th Revision, Clinical Modification.|
If your office has prescribed PERJETA, but your patient’s insurer has denied coverage, you can appeal that decision. PERJETA Access Solutions might be able to help you as you resolve the situation. Here is what you can do*:
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