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:


B18.1 Chronic viral hepatitis B without delta-agent
B18.2 Chronic viral hepatitis C

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 B18.1 Chronic viral hepatitis B without delta-agent
B18.2 Chronic viral hepatitis C
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  
0004-0350-09 00004-0350-09 180 mcg (1 single-use, prefilled syringe)
0004-0352-39 00004-0352-39 180 mcg (4 single-use, prefilled syringes)
0004-0365-30 00004-0365-30 180 mcg (4 single-use, prefilled autoinjectors)
0004-0360-30 00004-0360-30 135 mcg (4 single-use, prefilled autoinjectors)
0004-0357-30 00004-0357-30 180-mcg prefilled syringes (monthly convenience kit)

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

Appeals

If your office has prescribed PEGASYS, but your patient’s insurer has denied coverage, you can appeal that decision. 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. Complete and submit the required forms and documents to the insurer before the appeal deadline.