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.
For assistance obtaining ICD-10-CM codes, select an indication to start:
|C43.0*||Malignant melanoma of lip|
|C43.10||Malignant melanoma of unspecified eyelid, including canthus|
|C43.11||Malignant melanoma of right eyelid, including canthus|
|C43.12||Malignant melanoma of left eyelid, including canthus|
|C43.20||Malignant melanoma of unspecified ear and external auricular canal|
|C43.21||Malignant melanoma of right ear and external auricular canal|
|C43.22||Malignant melanoma of left ear and external auricular canal|
|C43.30||Malignant melanoma of unspecified part of face|
|C43.31||Malignant melanoma of nose|
|C43.39||Malignant melanoma of other parts of face|
|C43.4||Malignant melanoma of scalp and neck|
|C43.51||Malignant melanoma of anal skin|
|C43.52||Malignant melanoma of skin of breast|
|C43.59||Malignant melanoma of other part of trunk|
|C43.60||Malignant melanoma of unspecified upper limb, including shoulder|
|C43.61||Malignant melanoma of right upper limb, including shoulder|
|C43.62||Malignant melanoma of left upper limb, including shoulder|
|C43.70||Malignant melanoma of unspecified lower limb, including hip|
|C43.71||Malignant melanoma of right lower limb, including hip|
|C43.72||Malignant melanoma of left lower limb, including hip|
|C43.8||Malignant melanoma of overlapping sites of skin|
|C43.9||Malignant melanoma of skin, unspecified|
ZELBORAF 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.
Codes for Malignant Melanoma
|Diagnosis: ICD-10-CM||C43.0*—C43.9||Malignant melanoma of skin, by site|
|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.
|50242-090-02||50242-0090-02||240 mg (112 film-coated tablets)|
ICD-10-CM=International Classification of
Diseases, 10th Revision, Clinical Modification.
NDC=National Drug Code.
If your office has prescribed ZELBORAF, but your patient’s insurer has denied coverage, you can appeal that decision. ZELBORAF Access Solutions might be able to help you as you resolve the situation. Here is what you can do:
- 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.
- Contact ZELBORAF 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.
- Complete and submit the required forms and documents to the insurer before the appeal deadline. ZELBORAF Access Solutions can provide information about this process.
*This range of codes does not include melanoma in situ (D03.–), malignant melanoma of the skin of genital organs (C51–52, C60.–, C63.2), Merkel cell carcinoma (C4A.–), vermillion border of the lip (C00.0–C00.2), malignant neoplasm of the anus (C21.0), malignant neoplasm of scrotum (C63.2); plus, for melanoma of sites other than the skin (not previously specified), code to the malignant neoplasm of that site.