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:


C91.10 Chronic lymphocytic leukemia of B-cell type not having achieved remission
C91.12 Chronic lymphocytic leukemia of B-cell type in relapse

VENCLEXTA 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 C91.10 Chronic lymphocytic leukemia of B-cell type not having achieved remission, with failed remission or not otherwise specified
C91.12 Chronic lymphocytic leukemia of B-cell type in relapse
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  
0074-0579-28 00074-0579-28 Starting pack (contains 4 weekly wallet blister packs)
0074-0561-14 00074-0561-14 10 mg wallet (14 x 10 mg tablets)
0074-0566-07 00074-0566-07 50 mg wallet (7 x 50 mg tablets)
0074-0576-22 00074-0576-22 100 mg bottle (120 x 100 mg tablets)
0074-0561-11 00074-0561-11 10 mg unit dose (2 x 10 mg tablets)
0074-0566-11 00074-0566-11 50 mg unit dose (1 x 50 mg tablet)
0074-0576-11 00074-0576-11 100 mg unit dose (1 x 100 mg tablet)

ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification.
NDC=National Drug Code.

Appeals

If your office has prescribed VENCLEXTA, but your patient’s insurer has denied coverage, you can appeal that decision. VENCLEXTA Access Solutions 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 VENCLEXTA 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. VENCLEXTA Access Solutions can provide information about this process.