This coding information may assist you as you complete payer forms. 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 guarantee concerning reimbursement or coverage for any service or item.
For assistance obtaining ICD-10-CM codes, select an indication to start:
|C34.00||Malignant neoplasm of unspecified main bronchus|
|C34.01||Malignant neoplasm of right main bronchus|
|C34.02||Malignant neoplasm of left main bronchus|
|C34.10||Malignant neoplasm of upper lobe, unspecified bronchus or lung|
|C34.11||Malignant neoplasm of upper lobe, right bronchus or lung|
|C34.12||Malignant neoplasm of upper lobe, left bronchus or lung|
|C34.2||Malignant neoplasm of middle lobe, bronchus or lung|
|C34.30||Malignant neoplasm of lower lobe, unspecified bronchus or lung|
|C34.31||Malignant neoplasm of lower lobe, right bronchus or lung|
|C34.32||Malignant neoplasm of lower lobe, left bronchus or lung|
|C34.80||Malignant neoplasm of overlapping sites of unspecified bronchus and lung|
|C34.81||Malignant neoplasm of overlapping sites of right bronchus and lung|
|C34.82||Malignant neoplasm of overlapping sites of left bronchus and lung|
|C34.90||Malignant neoplasm of unspecified part of unspecified bronchus or lung|
|C34.91||Malignant neoplasm of unspecified part of right bronchus or lung|
|C34.92||Malignant neoplasm of unspecified part of left bronchus or lung|
ALECENSA ICD-10-CM Coding
These tables are provided for informational purposes only. Many payers will not accept unspecified codes. If you use an unspecified code, please check your payer. Correct coding is the responsibility of the provider.
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.
Non-small Cell Lung Cancer
|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: NDC |
Note: Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference.
|50242-130-01 ||50242-0130-01 ||150 mg (240 capsules)|
ICD-10-CM=International Classification of
Diseases, 10th Revision, Clinical Modification.
NDC=National Drug Code.
If your office has prescribed ALECENSA, but your patient’s insurer
has denied coverage, you can appeal that decision. Genentech
BioOncology Access Solutions for ALECENSA might be able to help you as
you resolve the situation. Here is what you can do:
- 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.
Genentech BioOncology 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.
- Complete and submit the required forms and documents to the
insurer before the appeal deadline. Genentech BioOncology Access
Solutions can provide information about this process.