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 and Novartis Pharmaceuticals Corporation do 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.
Moderate to Severe Persistent
|493.00||Extrinsic asthma, unspecified†|
|493.20||Chronic obstructive asthma, unspecified†|
Chronic Idiopathic Urticaria
|708.8||Other specified urticaria†|
|50242-040-62||50242-0040-62||150-mg single-use vial|
|Drug: HCPCS2§||J2357||Injection, omalizumab, 5 mg|
|Select Procedures, Services and Supplies: CPT||||96372||Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular¶|
|96401||Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic#|
|*||International Classification of Diseases—9th revision—Clinical Modification.|
|†||This description corresponds to the ICD-9 codes as determined by the Centers for Medicare & Medicaid Services. Please refer to the XOLAIR indications below.|
|‡||National Drug Code.|
|§||Healthcare Common Procedure Coding System.|
|||||Current Procedural Terminology (CPT®).|
|¶||XOLAIR is for subcutaneous use. Please refer to the XOLAIR indications below.|
|#||XOLAIR is not an anti-neoplastic agent. Please refer to the XOLAIR indications below.|
National Center for Health Statistics and the Centers for Medicare & Medicaid Services. The International Classification of Diseases, 9th Revision. Clinical Modification (ICD-9-CM), 6th edition. Hyattsville, MD: US Dept of Health and Human Services; 2011.
Centers for Medicare & Medicaid Services. 2013 table of drugs. http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Downloads/DRUG2013.pdf. Accessed December 4, 2013.
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 XOLAIR® (omalizumab), but your patient’s insurer has denied coverage, you can appeal that decision. XOLAIR Access Solutions and the XOLAIR Specialty Pharmacy Network might be able to help you as you resolve the situation. Here is what you can do*:
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