Reimbursement

TECENTRIQ Sample Coding

This coding information may assist you as you complete the payer forms for TECENTRIQ. 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.

Effective January 1, 2018, TECENTRIQ has been assigned a permanent HCPCS code (J-code). Please see the tables below for more information.

You can generate a PDF of these coding tables by selecting either the "Download All" or the "Download Section" button:

  • "Download All" lets you download or print a coding table for all indications
  • "Download Section" lets you download or print a coding table for a specific indication
TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CM C33
Malignant neoplasm of trachea
C34.00–C34.02 Malignant neoplasm of bronchus and lung; main bronchus
C34.10–C34.12 Malignant neoplasm of bronchus and lung; upper lobe
C34.2
Malignant neoplasm of bronchus and lung; middle lobe
C34.30–C34.32 Malignant neoplasm of bronchus and lung; lower lobe
C34.80–C34.82 Malignant neoplasm of bronchus and lung; overlapping sites
C34.90–C34.92
Malignant neoplasm of bronchus and lung; unspecified part
Permanent HCPCS
EFFECTIVE JANUARY 1, 2018
J9022
Injection, atezolizumab, 10 mg
Miscellaneous HCPCS J3590
Unclassified biologics
J3490
Unclassified drugs
J9999
Not otherwise classified, antineoplastic drugs
Hospital Outpatient HCPCS C9483
Injection, atezolizumab, 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  
50242-917-01 50242-0917-01 1200 mg/20 mL single dose 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)

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 C65.1
Malignant neoplasm of the right renal pelvis
C65.2
Malignant neoplasm of the left renal pelvis
C65.9
Malignant neoplasm of unspecified renal pelvis
C66.1
Malignant neoplasm of the right ureter
C66.2
Malignant neoplasm of the left ureter
C66.9
Malignant neoplasm of unspecified ureter
Permanent HCPCS
EFFECTIVE JANUARY 1, 2018
J9022
Injection, atezolizumab, 10 mg
Miscellaneous HCPCS J3590
Unclassified biologics
J3490
Unclassified drugs
J9999
Not otherwise classified, antineoplastic drugs
Hospital Outpatient HCPCS C9483
Injection, atezolizumab, 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  
50242-917-01 50242-0917-01 1200 mg/20 mL single dose 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)

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 C67.0
Malignant neoplasm of trigone of bladder
C67.1
Malignant neoplasm of dome of bladder
C67.2
Malignant neoplasm of lateral wall of bladder
C67.3
Malignant neoplasm of anterior wall of bladder
C67.4
Malignant neoplasm of posterior wall of bladder
C67.5
Malignant neoplasm of bladder neck
C67.6
Malignant neoplasm of ureteric orifice
C67.7
Malignant neoplasm of urachus
C67.8
Malignant neoplasm of overlapping sites of bladder
C67.9
Malignant neoplasm of bladder, unspecified
C68.0
Malignant neoplasm of the urethra
Permanent HCPCS
EFFECTIVE JANUARY 1, 2018
J9022
Injection, atezolizumab, 10 mg
Miscellaneous HCPCS J3590 Unclassified biologics
J3490 Unclassified drugs
J9999 Not otherwise classified, antineoplastic drugs
Hospital Outpatient HCPCS C9483 Injection, atezolizumab, 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  
50242-917-01 50242-0917-01 1200 mg/20 mL single dose 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)

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 Genentech BioOncology® Access Solutions for TECENTRIQ 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

Play Video

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.

Important Safety Information & Indication

Indication

TECENTRIQ (atezolizumab) is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who:

  • Are not eligible for cisplatin-containing chemotherapy, or
  • Have disease progression during or following any platinum-containing chemotherapy, or within 12 months of neoadjuvant or adjuvant chemotherapy

This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

TECENTRIQ is indicated for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) who have disease progression during or following platinum-containing chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving TECENTRIQ.

Important Safety Information

Serious Adverse Reactions

Please refer to the full Prescribing Information for important dose modification information specific to adverse reactions.

  • Immune-mediated pneumonitis. Immune-mediated pneumonitis or interstitial lung disease, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for Grade 3 or 4 pneumonitis
  • Immune-mediated hepatitis. Immune-mediated hepatitis and liver test abnormalities, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for AST or ALT elevations more than 8 times the upper limit of normal or total bilirubin more than 3 times the upper limit of normal
  • Immune-mediated colitis. Immune-mediated colitis or diarrhea have occurred. Permanently discontinue TECENTRIQ for Grade 4 diarrhea or colitis
  • Immune-mediated endocrinopathies. Thyroid disorders, adrenal insufficiency, type 1 diabetes mellitus, including diabetic ketoacidosis, and hypophysitis/hypopituitarism have occurred
  • Other immune-mediated adverse reactions. TECENTRIQ can cause severe and fatal immune-mediated adverse reactions. These immune-mediated reactions may involve any organ system. Permanently discontinue TECENTRIQ for Grade 4 immune-mediated adverse reactions involving a major organ
  • Infections. Severe infections, including fatal cases, have occurred
  • Infusion-related reactions. Severe or life-threatening infusion-related reactions have occurred. Permanently discontinue TECENTRIQ in patients with Grade 3 or 4 infusion-related reactions
  • Embryo-fetal toxicity. TECENTRIQ can cause fetal harm in pregnant women. Verify pregnancy status prior to initiating TECENTRIQ. Advise patients of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TECENTRIQ and for at least 5 months after the last dose
  • Advise female patients not to breastfeed while taking TECENTRIQ and for at least 5 months after the last dose

Most Common Adverse Reactions

The most common adverse reactions in cisplatin-ineligible UC (rate ≥20%) were fatigue (52%), decreased appetite (24%), diarrhea (24%), and nausea (22%).

The most common adverse reactions in previously treated UC (rate ≥20%) were fatigue (52%), decreased appetite (26%), nausea (25%), urinary tract infection (22%), pyrexia (21%), and constipation (21%).

The most common adverse reactions in NSCLC (rate ≥20%) were fatigue (43.5%), decreased appetite (23.5%), dyspnea (22%), and cough (26.4%).

You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.

Please see the full Prescribing Information for additional Important Safety Information.