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.

TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CM 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
Drug: HCPCS J3590
Unclassified biologics
J3490
Unclassified drugs
J9999
Not otherwise classified, antineoplastic drugs
Hospital Outpatient HCPCS C9483
Injection, atezolizumab, 10mg
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
Drug: 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
Drug: 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

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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.