Reimbursement

Avastin Sample Coding

This coding information may assist you as you complete the payer forms for Avastin. These tables are provided for informational purposes only. 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.

TYPE CODE DESCRIPTION
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 J9035 Injection, bevacizumab, 10 mg
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.
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
Administration procedures: 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)

 

CPT=Current Procedural Terminology.
HCPCS=Healthcare Common Procedure Coding System.
ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification.
NDC=National Drug Code.

TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CM C34.00—C34.02 Malignant neoplasm of bronchus and lung, main bronchus
C34.10—C34.12 Malignant neoplasm of upper lobe, bronchus or lung
C34.2 Malignant neoplasm of middle lobe; bronchus or lung
C34.30—C34.32 Malignant neoplasm of lower lobe, bronchus or lung
C34.80—C34.82 Malignant neoplasm of overlapping sites, bronchus or lung
C34.90—C34.92 Malignant neoplasm of unspecified part, bronchus or lung
Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
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.
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
Administration procedures: 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)

 

CPT=Current Procedural Terminology.
HCPCS=Healthcare Common Procedure Coding System.
ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification.
NDC=National Drug Code. 

TYPE CODE DESCRIPTION

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
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.
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
Administration procedures: 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)

 

CPT=Current Procedural Terminology.
HCPCS=Healthcare Common Procedure Coding System.
ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification.
NDC=National Drug Code. 

TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CM C71.0—C71.9 Malignant neoplasm of brain
Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
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.
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
Administration procedures: 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)

 

CPT=Current Procedural Terminology.
HCPCS=Healthcare Common Procedure Coding System.
ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification.
NDC=National Drug Code. 

TYPE CODE DESCRIPTION
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 J9035 Injection, bevacizumab, 10 mg
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.
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
Administration procedures: 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)

 

CPT=Current Procedural Terminology.
HCPCS=Healthcare Common Procedure Coding System.
ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification.
NDC=National Drug Code. 

TYPE CODE DESCRIPTION
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 unspecified, right, and left fallopian tube(s)
C48.1—C48.2 Malignant neoplasm of specified parts of peritoneum and unspecified parts of the peritoneum
C48.8 Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
Drug: HCPCS J9035 Injection, bevacizumab, 10 mg
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.
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
Administration procedures: 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)

 

CPT=Current Procedural Terminology.
HCPCS=Healthcare Common Procedure Coding System.
ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification.
NDC=National Drug Code. 

These codes are not all-inclusive; appropriate codes can vary by patient, setting of care and payer. 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.

Many payers will not accept unspecified codes. If you use an unspecified code, please check with your payer.

Appeals

If your patient’s health insurance plan has issued a denial, your BioOncology Field Reimbursement Manager (BFRM) or Avastin Access Solutions Specialist can provide resources as you prepare an appeal submission, as per your patient’s plan requirements.

If a plan issues a denial:

  1. The denial should be reviewed, along with the health insurance plan’s guidelines to determine what to include in your patient’s appeal submission.
  2. Your BFRM or Avastin Access Solutions Specialist has local payer coverage expertise and can help you determine specific requirements for your patient.

A sample appeal letter, checklist and additional tips are available in Forms and Documents.

Appeals cannot be completed or submitted by Avastin Access Solutions on your behalf.

PAN=Patient Authorization and Notice of Request for Transmission of Health Information to Genentech Access Solutions and Genentech® Access to Care Foundation.

SMN=Statement of Medical Necessity.