Reimbursement

RITUXAN HYCELA Sample Coding

This coding information may assist you as you complete the payer forms for RITUXAN HYCELA. 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 C82.90—C82.99
Follicular lymphoma, unspecified
C82.00—C82.09 Follicular lymphoma grade I
C82.10—C82.19
Follicular lymphoma grade II
C82.20—C82.29
Follicular lymphoma grade III, unspecified
C82.30—C82.39
Follicular lymphoma grade IIIa
C82.40—C82.49
Follicular lymphoma grade IIIb
C82.50—C82.59
Diffuse follicle center lymphoma
C82.60—C82.69
Cutaneous follicle center lymphoma
C82.80—C82.89
Other types of follicular lymphoma
Drug: HCPCS J3590 Unclassified biologics
J3490 Unclassified drugs
J9999 Not otherwise classified, antineoplastic drugs

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  
50242-108-01 50242-0108-01 1,400 mg rituximab and 23,400 Units hyaluronidase human per 11.7 mL
(120 mg/2,000 Units per mL) solution in a single-dose vial
50242-109-01 50242-0109-01 1,600 mg rituximab and 26,800 Units hyaluronidase human per 13.4 mL
(120 mg/2,000 Units per mL) solution in a single-dose vial
Administration procedures: CPT 96401
Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic

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 C83.30—C83.39
Diffuse large B-cell lymphoma
Drug: HCPCS J3590 Unclassified biologics
J3490 Unclassified drugs
J9999 Not otherwise classified, antineoplastic drugs
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  
50242-108-01
50242-0108-01
1,400 mg rituximab and 23,400 Units hyaluronidase human per 11.7 mL
(120 mg/2,000 Units per mL) solution in a single-dose vial
50242-109-01
50242-0109-01
1,600 mg rituximab and 26,800 Units hyaluronidase human per 13.4 mL
(120 mg/2,000 Units per mL) solution in a single-dose vial
Administration procedures: CPT 96401
Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic

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 C91.10 Chronic lymphocytic leukemia of B-cell type not having achieved remission
C91.12 Chronic lymphocytic leukemia of B-cell type in relapse
Drug: HCPCS J3590 Unclassified biologics
J3490 Unclassified drugs
J9999 Not otherwise classified, antineoplastic drugs
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  
50242-108-01
50242-0108-01
1,400 mg rituximab and 23,400 Units hyaluronidase human per 11.7 mL
(120 mg/2,000 Units per mL) solution in a single-dose vial
50242-109-01
50242-0109-01
1,600 mg rituximab and 26,800 Units hyaluronidase human per 13.4 mL
(120 mg/2,000 Units per mL) solution in a single dose vial
Administration procedures: CPT 96401
Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic

 

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

Appeals

If your patient’s health insurance plan has issued a denial, your BioOncology Field Reimbursement Manager (BFRM) or Genentech BioOncology® Access Solutions for RITUXAN HYCELA 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 Genentech BioOncology 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 BioOncology Access Solutions on your behalf.

Understanding Claims Submission for Office-administered Products Using a Miscellaneous J-code Video

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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.