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:


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
C65.1 Malignant neoplasm of the right renal pelvis
C65.2 Malignant neoplasm of the left renal pelvis
C65.9 Malignant neoplasm of the unspecified renal pelvis
C66.1 Malignant neoplasm of the right ureter
C66.2 Malignant neoplasm of the left ureter
C66.9 Malignant neoplasm of the unspecified ureter
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

TECENTRIQ 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 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.

Appeals

If your office has prescribed TECENTRIQ, but your patient’s insurer has denied coverage, you can appeal that decision. Genentech BioOncology Access Solutions for TECENTRIQ might be able to help you as you resolve the situation. 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. Contact Genentech BioOncology Access Solutions for guidance as you put together an appeal. Use these resources to help you gather the documents and information you need for a successful appeal.
  3. Complete and submit the required forms and documents to the insurer before the appeal deadline. Genentech BioOncology Access Solutions can provide information about this process.

Understanding Claims Submission for Office-administered Products with a Miscellaneous J Code Video

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