Oncology & Hematology Coding Alert

Prepare to include J9271 and J9308 in the list of your chemo codes.

Here are two key HCPCS code updates that have been effective since Jan 1, 2016. You can’t afford to miss these this year.

Locate Permanent J-Code for Keytruda^®

The Center for Medicare and Medicaid Services (CMS) has now introduced a permanent J-Code for Keytruda^®. Effective January 1, 2016, the permanent J code for Keytruda^® is J9271 (Injection, Pembrolizumab, 1 mg). This means for dates of service on or after January 1, 2016, you would submit claims with code J9271. You submit one unit of code J9271 for every 1 mg of pembrolizumab injected.

What is pembrolizumab? Pembrolizumab is the first human Programmed death ligand 1 (PD-1) inhibitor to receive FDA approval for PD-L1 positive non-small cell lung cancer (NSCLC) in the United States. On October 2, 2015, the FDA approved pembrolizumab for the treatment of patients with metastatic NSCLC. 

You can read the published scientific evidence for pembrolizumab in “Pembrolizumab for the treatment of non-small cell lung cancer. Lim SH et al. Expert Opin Biol Ther. (2016),” PMID: 26800463.

Look For New HCPCS Code for Cyramza

Effective January 1, 2016, you can submit the new code J9308 (Injection, ramucirumab, 5 mg) for Cyramza (ramucirumab). You submit one unit of code J9308 for every 5 mg of ramucirumab your physician administers.

What are National Drug Codes (NDC): The NDC for ramucirumab are 00002-7669-01 for the 100mg/10 ml strength and 00002-7678-01 for the 500 mg/50 ml strength. The NDC codes have ‘zeros’ to make these complete 11-digit codes to meet the Health Insurance Portability and Accountability Act (HIPAA) standards.

NDC codes are unique, three-segment number, which are essentially universal product identifier for drugs. The FDA publishes the listed NDC numbers and the information submitted as part of the listing information in the NDC Directory, which is updated daily.

What is ramucirumab? Ramucirumab is a fully human monoclonal antibody that is a human vascular endothelial growth factor receptor 2 antagonist and is used in the treatment of solid tumors.