Rituxan Sample Coding
This coding information may assist you as you complete the payer forms for Rituxan. 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.
Rheumatoid Arthritis (RA)
|Diagnosis: ICD-10-CM||M05.60—M05.69||Rheumatoid arthritis with involvement of other organs and systems|
|M05.70—M05.79||Rheumatoid arthritis with rheumatoid factor without organ or systems involvement|
|M06.00—M06.09||Rheumatoid arthritis without rheumatoid factor|
|M06.9||Rheumatoid arthritis, unspecified|
|Drug: HCPCS||J9310||Injection, rituximab, 100 mg|
|Other drugs: for ancillary premedications and supplies as appropriate||J1100||Injection, dexamethasone sodium phosphate, 1 mg|
|J1200||Injection, diphenhydramine HCL, up to 50 mg|
|J2920||Injection, methylprednisolone sodium succinate, up to 40 mg|
|J2930||Injection, methylprednisolone sodium succinate, up to 125 mg|
|J7030||Infusion, normal saline solution, 1000 cc|
|J7040||Infusion, normal saline solution, sterile (500 mL = 1 unit)|
|J7050||Infusion, normal saline solution, 250 cc|
|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.
|50242-051-21||50242-0051-21||100 mg/10 mL single-use vial|
|50242-053-06||50242-0053-06||500 mg/50 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)|
|96367||Intravenous infusion, for therapy,
prophylaxis or diagnosis (specify substance or drug); additional
sequential infusion, up to 1 hour (List separately in addition
to code for primary procedure) |
(Report 96367 in conjunction with 96365, 96374, 96409, 96413 if provided as a secondary or subsequent service after a different initial service is administered through the same IV access. Report 96367 only once per sequential infusion of same infusate mix)
|96375||Intravenous infusion, for therapy,
prophylaxis or diagnosis (specify substance or drug); each
additional sequential intravenous push of a new substance/drug
(List separately in addition to code for primary
(Use 96375 in conjunction with 96365, 96374, 96409, 96413)
(Report 96375 to identify intravenous push of a new substance/drug if provided as a secondary or subsequent service after a different initial service is administered through the same IV access)
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 and Biogen do 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.
If your patient’s health insurance plan has issued a denial, your Immunology Field Reimbursement Manager (IFRM) or Genentech Rheumatology 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:
- The denial should be reviewed, along with the health insurance
plan’s guidelines to determine what to include in your patient’s
- Your IFRM or Genentech Rheumatology 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 Genentech Rheumatology 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.