Reimbursement

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.

ICD-10-CM Tool

ICD-10-CM:


C44.01 Basal cell carcinoma of skin of lip
C44.111 Basal cell carcinoma of skin of unspecified eyelid, including canthus
C44.112 Basal cell carcinoma of skin of right eyelid, including canthus
C44.119 Basal cell carcinoma of skin of left eyelid, including canthus
C44.211 Basal cell carcinoma of skin of unspecified ear and external auricular canal
C44.212 Basal cell carcinoma of skin of right ear and external auricular canal
C44.219 Basal cell carcinoma of skin of left ear and external auricular canal
C44.310 Basal cell carcinoma of skin of unspecified parts of face
C44.311 Basal cell carcinoma of skin of nose
C44.319 Basal cell carcinoma of skin of other parts of face
C44.41 Basal cell carcinoma of skin of scalp and neck
C44.510 Basal cell carcinoma of anal skin
C44.511 Basal cell carcinoma of skin of breast
C44.519 Basal cell carcinoma of skin of other part of trunk
C44.611 Basal cell carcinoma of skin of unspecified upper limb, including shoulder
C44.612 Basal cell carcinoma of skin of right upper limb, including shoulder
C44.619 Basal cell carcinoma of skin of left upper limb, including shoulder
C44.711 Basal cell carcinoma of skin of unspecified lower limb, including hip
C44.712 Basal cell carcinoma of skin of right lower limb, including hip
C44.719 Basal cell carcinoma of skin of left lower limb, including hip
C44.81 Basal cell carcinoma of overlapping sites of skin
C44.91 Basal cell carcinoma of skin, unspecified

Erivedge 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.

TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CM C44.01 Basal cell carcinoma of various sites, overlapping sites and unspecified
C44.111—C.44.119
C44.211—C44.219
C44.310—C44.319
C44.41
C44.510—C44.519
C44.611—C44.619
C44.711—C44.719
C44.81
C44.91
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  
50242-140-01 50242-0140-01 150 mg (28 capsules)

 

ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification.
NDC=National Drug Code. 

Appeals

If your office has prescribed Erivedge, but your patient’s insurer has denied coverage, you can appeal that decision. Erivedge 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 Erivedge 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. Erivedge Access Solutions can provide information about this process.