Billing and Coding Information

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ERBITUX Billing and Coding Information

Use this information when preparing documentation for ERBITUX use.

HCPCS Codes

HCPCS Code

Code

Description

J9055

Injection, cetuximab (billing unit = 10 mg)

NDC

The NDCs for ERBITUX, listed in the table below, are often necessary in addition to the appropriate J- or C-code when filing a claim for reimbursement.

Code

Dosage form and strength

66733-948-23
66733-0948-23

ERBITUX (cetuximab for injection) 100 mg/50 mL vial

66733-958-23
66733-0958-23

ERBITUX (cetuximab for injection) 200 mg/100 mL vial

5010 Electronic Transaction Coding

  • For electronic transactions, including 837P and 837I, the NDC is to be preceded with the qualifier N4 and followed immediately by the 11-digit NDC for payers who require it
  • This is typically followed by the NDC unit of measure: UN (units), F2 (international units), GR (gram), or ML (milliliter) of the amount administered
How SuppliedNDCNDC QualifierNDC Basis of MeasurementSample NDC 5010 Format
100 mg/50 mL, single-use vial66733-0948-23N4MLN466733094823ML50
200 mg/100 mL, single-use vial66733-0958-23N4MLN466733095823ML100

The examples given for the sample NDC 5010 format demonstrate NDC quantity reporting for 1 vial of ERBITUX. The actual amount of drug used can vary based on factors such as patient weight. Currently, reporting NDC quantity varies from payer to payer, so the provider should consult each specific payer to determine the required format.

Diagnosis Codes

Diagnosis Codes for Colorectal Cancer

ICD-10-CM

Description

C18

Malignant neoplasm of colon

C18.0

Malignant neoplasm of cecum

C18.1

Malignant neoplasm of appendix

C18.2

Malignant neoplasm of ascending colon

C18.3

Malignant neoplasm of hepatic flexure

C18.4

Malignant neoplasm of transverse colon

C18.5

Malignant neoplasm of splenic flexure

C18.6

Malignant neoplasm of descending colon

C18.7

Malignant neoplasm of sigmoid colon

C18.8

Malignant neoplasm of overlapping sites of colon

C18.9

Malignant neoplasm of colon, unspecified

C19

Malignant neoplasm of rectosigmoid junction

C20

Malignant neoplasm of rectum

C21

Malignant neoplasm of anus and anal canal

C21.8

Malignant neoplasm of overlapping sites of rectum, anus, and anal canal

Diagnosis Codes for Head and Neck Cancer

ICD-10-CM

Description

C00

Malignant neoplasm of lip

C00.0

Malignant neoplasm of external upper lip

C00.1

Malignant neoplasm of external lower lip

C00.2

Malignant neoplasm of external lip, unspecified

C00.3

Malignant neoplasm of upper lip, inner aspect

C00.4

Malignant neoplasm of lower lip, inner aspect

C00.5

Malignant neoplasm of lip, unspecified, inner aspect

C00.6

Malignant neoplasm of commissure of lip, unspecified

C00.8

Malignant neoplasm of overlapping sites of lip

C00.9

Malignant neoplasm of lip, unspecified

C01

Malignant neoplasm of base of tongue

C02

Malignant neoplasm of other and unspecified parts of tongue

C02.0

Malignant neoplasm of dorsal surface of tongue

C02.1

Malignant neoplasm of border of tongue

C02.2

Malignant neoplasm of ventral surface of tongue

C02.3

Malignant neoplasm of anterior two-thirds of tongue, part unspecified

C02.4

Malignant neoplasm of lingual tonsil

C02.8

Malignant neoplasm of overlapping sites of tongue

C02.9

Malignant neoplasm of tongue, unspecified

C03

Malignant neoplasm of gum

C03.0

Malignant neoplasm of upper gum

C03.1

Malignant neoplasm of lower gum

C03.9

Malignant neoplasm of gum, unspecified

C04

Malignant neoplasm of floor of mouth

C04.0

Malignant neoplasm of anterior floor of mouth

C04.1

Malignant neoplasm of lateral floor of mouth

C04.8

Malignant neoplasm of overlapping sites of floor of mouth

C04.9

Malignant neoplasm of floor of mouth, unspecified

C05

Malignant neoplasm of palate

C05.0

Malignant neoplasm of hard palate

C05.1

Malignant neoplasm of soft palate

C05.2

Malignant neoplasm of uvula

C05.8

Malignant neoplasm of overlapping sites of palate

C05.9

Malignant neoplasm of palate, unspecified

C06

Malignant neoplasm of other and unspecified parts of mouth

C06.0

Malignant neoplasm of cheek mucosa

C06.1

Malignant neoplasm of vestibule of mouth

C06.2

Malignant neoplasm of retromolar area

C06.80

Malignant neoplasm of overlapping sites of unspecified parts of mouth

C06.89

Malignant neoplasm of overlapping sites of other parts of mouth

C06.9

Malignant neoplasm of mouth, unspecified

C09

Malignant neoplasm of tonsil

C09.0

Malignant neoplasm of tonsillar fossa

C09.1

Malignant neoplasm of tonsillar pillar (anterior) (posterior)

C09.8

Malignant neoplasm of overlapping sites of tonsil

C09.9

Malignant neoplasm of tonsil, unspecified

C10

Malignant neoplasm of oropharynx

C10.0

Malignant neoplasm of vallecula

C10.1

Malignant neoplasm of anterior surface of epiglottis

C10.2

Malignant neoplasm of lateral wall of oropharynx

C10.3

Malignant neoplasm of posterior wall of oropharynx

C10.4

Malignant neoplasm of branchial cleft

C10.8

Malignant neoplasm of overlapping sites of oropharynx

C10.9

Malignant neoplasm of oropharynx, unspecified

C12

Malignant neoplasm of pyriform sinus

C13

Malignant neoplasm of hypopharynx

C13.0

Malignant neoplasm of postcricoid region

C13.1

Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect

C13.2

Malignant neoplasm of posterior wall of hypopharynx

C13.8

Malignant neoplasm of overlapping sites of hypopharynx

C13.9

Malignant neoplasm of hypopharynx, unspecified

C14

Malignant neoplasm of other and ill-defined sites in the lip, oral cavity, and pharynx

C14.0

Malignant neoplasm of pharynx, unspecified

C14.2

Malignant neoplasm of Waldeyer’s ring

C14.8

Malignant neoplasm of overlapping sites of lip, oral cavity, and pharynx

C30

Malignant neoplasm of nasal cavity

C30.0

Malignant neoplasm of nasal cavity

C31

Malignant neoplasm of accessory sinuses

C31.0

Malignant neoplasm of maxillary sinus

C31.1

Malignant neoplasm of ethmoidal sinus

C31.2

Malignant neoplasm of frontal sinus

C31.3

Malignant neoplasm of sphenoid sinus

C31.8

Malignant neoplasm of overlapping sites of accessory sinuses

C31.9

Malignant neoplasm of accessory sinus, unspecified

C32

Malignant neoplasm of larynx

C32.0

Malignant neoplasm of glottis

C32.1

Malignant neoplasm of supraglottis

C32.2

Malignant neoplasm of subglottis

C32.3

Malignant neoplasm of laryngeal cartilage

C32.8

Malignant neoplasm of overlapping sites of larynx

C32.9

Malignant neoplasm of larynx, unspecified

C76

Malignant neoplasm of other and ill-defined sites

C76.0

Malignant neoplasm of head, face, and neck

Drug Administration CPT® Codes

The CPT and APC codes that may be appropriate when administering ERBITUX appear in the table below.

CPT Code

Description

APC

96413

Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

0440

96415

Chemotherapy administration, intravenous infusion technique; each additional hour (list separately in addition to code for primary procedure)

0437

96417

Each additional sequential infusion (different substance/drug); up to 1 hour (list separately in addition to code for primary procedure)*

0438

KRAS Testing Codes

The following table includes codes that are appropriate for KRAS mutation testing.

Code

Description

81210

BRAF (B-Raf proto-oncogene, serine/threonine kinase) (eg,colon cancer, melanoma), gene analysis, V600 variant (s)

81275

KRAS (v-Ki-ras 2 Kirsten rat sarcoma viral oncogene) (eg, carcinoma) gene analysis, variants in codons 12 and 13

81276

KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma gene analysis; additional variant (s) (eg, codon 61, codon 146)

81311

NRAS; (neuroblastoma RAS viral [v-ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg,codon 61)

81403

Molecular pathology procedure, level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in two or more independent reactions, mutation scanning, or duplication/deletion variants of 2-5 exons)

81405

Molecular pathology procedure, level 6 (eg, analysis of 6-10 exons by DNA sequence analysis, mutation scanning, or duplication/deletion variants of 11-25 exons), regionally targeted cytogenomic array assay

81445

Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, NRAS, MET, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed

81455

Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm, DNA and RNA analysis when performed, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NPM1, NRAS, MET, NOTCH1, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed

88363

Examination and selection of retrieved archival (ie, previously diagnosed) tissue(s) for molecular analysis (eg, KRAS mutational analysis)

Medicare coverage of KRAS mutation testing may vary at the local level. Providers should consult their local Medicare contractor to ascertain KRAS mutation testing coverage and reimbursement for their Medicare patients.

*Typically not applicable for the administration of ERBITUX but may be used if different substances are administered sequentially.


Ordering Information

Use these product codes to order ERBITUX in the appropriate vials.

Product Codes

Lilly Product Code

LY2939777

ERBITUX UPC

100 mg: 366733948232

200 mg: 366733958231

NDC

100 mg: 66733-948-23

200 mg: 66733-958-23

This information is presented for informational purposes only and is not intended to provide reimbursement or legal advice. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. Individual coding decisions should be based upon diagnosis and treatment of individual patients. Eli Lilly and Company does not guarantee success in obtaining insurance payments. While we have made an effort to be current as of the issue date of this website, the information may not be as current or comprehensive when you view it. Providers should contact third-party payers for specific information on their coverage, coding, and payment policies. Please consult with your legal counsel or reimbursement specialist for any reimbursement or billing questions. For more information, please call the Lilly PatientOne program at 1-866-472-8663.