In august 2012, zivaflibercept became eligible for medicare reimbursement but did not have an assigned hcpcs code. Ziv aflibercept will be given as a single line of therapy. Patient continues to meet indicationspecific relevant criteria such as concomitant therapy. The use of na indicates that the hcpcs code was not available. Adult guidelines for assessment and management of nausea. J9400 hcpcs code for injection, zivaflibercept, 1 mg. The recommended ziv aflibercept dose and schedule is 4 mgkg administered as a 60minute iv. Hcpcs generic name brand name effective date end date page 1 revised. Medical oncology prior authorization list for uaw retiree.
Successfully coding retina injectable drugs retina today. Cms administers part b and contracts with medicare. L0455, tlso, flexible, provides trunk support, extends from sacrococcygeal junction to above t9 vertebra. Uphp keywords hcpcs, jcodes, pharmacy created date. Ziv aflibercept may be initiated or resumed once the surgical wound is fully healed after minor surgery e. The recommended ziv aflibercept dose and schedule is 4 mgkg administered as a 60minute iv infusion every 2 weeks in combination with the folfiri regimen. Hcpcs j codes typically includes drugs that cannot selfadministered, are reasonable and necessary for the treatment of the injury or illness and considered effective by the fda, among other requirements. A j code may cover the supply, injection or infusion of a drug or. And patient has received previous adjuvant folfox fluorouracil, leucovorin, and. Department of heathl care servcesi heatlhcare common. J9400 is a valid 2021 hcpcs code for injection, ziv aflibercept, 1 mg or just inj, ziv aflibercept, 1mg for short, used in medical care. Administering intravitreal injections of ziv aflibercept will continue to rest in the realms of the brave until considerably more data is available on its use.
Zaltrap zivaflibercept dose, indications, adverse effects. Department of health and human services centers for medicare. Hcpcs code j9400 for injection, ziv aflibercept, 1 mg as maintained by cms. Bestcorrected visual acuity bcva in snellen and logarithm of minimum angle of resolution logmar, central. The medicare contractor for jurisdiction 1 overpaid a. Medicare prior authorization list snpmapdmmp absolute total. Ziv aflibercept will be used in combination with an irinotecan based regimen. Beginning july 2012, providers billed medicare using hcpcs code q2046 and then changed to j0178 effective january 20. J9600 hcpcs code for injection, porfimer sodium, 75 mg. Hcpcs j9400 injection, ziv aflibercept, 1 mg hcpcs j9999 not otherwise classified, antineoplastic drugs 1 twodigit numeric codes are level i code modifiers ed by the american medical associations current procedural terminology cpt. Ndc pharmacologic class n0000193543 vascular endothelial. The nonproprietary name is sometimes called the generic name. Zivaflibercept binds vegfa, b and plgf and has improved survival in refractory metastatic colorectal cancer.
Restricted access do not disseminate or copy without approval. Hcpcs generic name brand name effective end date date. It could also provide a second line of therapy in eyes with wet amd or dme resistant to. This crosswalk is intended to help the public understand which drug products identified by ndcs are assigned to which hcpcs billing. Ziv aflibercept is approved to be used with folfiri to treat. Injectable medications subject to medical necessity and. Hcpcs codes description j9400 injection, ziv aflibercept, 1 mg. Renewal criteria1,2 coverage can be renewed based upon the following criteria. Drug name hcpcs code if known ziv aflibercept zaltrap j9400.
Drugs dispensed to a patient and immunizations are likely not covered by a j code. Icd9cm, cpt, andor hcpcs codes should be selected and used by physicians based upon the code or codes that most accurately describe the diagnosis and. Mt included healthcon 2021 and code book and exam prep dos and. C9296 injection, ziv aflibercept, 1 mg k2 j1744 injection, icatibant, 1 mg k2 j2212 injection, methylnaltrexone, 0. This code description may also have includes, excludes, notes, guidelines, examples and other information. It was developed by regeneron pharmaceuticals and is approved in the united states and the european union. It is used in patients whose disease has not gotten better with other chemotherapy. For complete cpthcpcs code listing, please see online prior authorization tool on health plan website. Aflibercept is a decoy fusion protein of domain 2 of vegfr1 and domain 3 of vegfr2 with the fc fragment of igg1 2 r, 3 r.
For private sector health insurance systems, please contact the individual private insurance entity. J9395 hcpcs code for injection, fulvestrant, 25 mg. It was developed by regeneron pharmaceuticals and is approved in the united states and the european union it is. Part b of medicare provides supplementary medical insurance, including limited coverage for the cost of outpatient drugs and biologicals that are furnished incident to a physicians service and are not usually selfadministered. This detailed description can be identified in an hcpcs coding book. Chlorpromazine hydrochloride, 10 mg, oral, fda approved prescription. Food and drug administration fda on august 3, 2012 for use in combination with 5fluorouracil, leucovorin, irinotecanfolfiri in metastatic colorectal cancer that is resistant to or has progressed following an oxaliplatincontaining regimen. Ziv aflibercept zaltrap is a vascular endothelial growth factor vegf inhibitor. The following codes should be utilized for billing. National comprehensive cancer network, nccn, and nccn guidelines are trademarks owned by the national comprehensive cancer network, inc.
Zivaflibercept is a soluble fusion protein that functions as an angiogenic trap by preventing the binding of soluble proangiogenic ligands vegfa, vegfb, and placental growth factor. Injection, leucovorin calcium, per 50 mg folinic acid j0641. Injection, zivaflibercept, 1 mg j9400 hcpcs codes codify. Providers are responsible for informing their billing agency of information in this bulletin. Zaltrap ziv aflibercept injection for intravenous infusion prior approval is required for some or all procedure codes listed in this corporate drug policy. Zivaflibercept zaltrap ambetter from superior healthplan.
Each hcpcs code in this list must be accompanied by a valid ndc in the lin03 segment of the hipaa 837 transactoi n. Cpt codes, descriptors, and other data only are 2011 american medical association. Overview zaltrap is a recombinant fusion protein consisting of vascular. Analytical comparability assessment on glycosylation of.
Hcpcs code j9400 for injection, zivaflibercept, 1 mg as maintained by cms. Hcpcs code description j9400 injection, ziv aflibercept, 1mg. Comparison of loading doses of zivaflibercept and afliberce. Ziv aflibercept will not be used in combination with the same irinotecan based regimen that was previously used in combination with bevacizumab. It is an inhibitor of vascular endothelial growth factor vegf. Aflibercept is a drug used for the treatment of patients with agerelated macular degeneration. Coding for injectable drugs american academy of ophthalmology. The optum hcpcs level ii book provides colored symbols for each coverage and reimbursement instruction. Dec 03, 2020 zaltrap ziv aflibercept iv zaltrap ziv aflibercept in combination with 5fluorouracil or equivalent eg, capecitabine, floxuridine, leucovorin, irinotecanfolfiri may be considered medically necessary for patients with metastatic colorectal cancer mcrc that is resistant to or has progressed following an oxaliplatincontaining regimen.
The 2014 hcpcs updates new, revised, and discontinued. Full prescribing information, including boxed warning, clinical trial information, safety, dosing. Medication brand name generic medication name hcpcs code 2effective date durolane hyaluronan or derivative j7318 212019 gelone hyaluronan or derivative j7326 gelsyn3 hyaluronan or derivative j7328. Injection, zivaflibercept, 1 mg j9400 hcpcs codes codify by. The medicare contractor for jurisdiction 1 overpaid a provider that. A legend to these symbols is provided on the bottom of each twopage spread. Na may mean that a the hcpcs code has not yet been created new drug, b the drug is given as an oral drug or alternative route only in specific instances are hcpcs assigned to these medications, or c the hcpcs could not be found or is truly not available. It is approved for the treatment of wet agerelated macular degeneration 5 s, 6 r and in combination with 5fluorouracil. Injection, ziv aflibercept, 1 mg drugs administered other than oral method, chemotherapy drugs j9400 is a valid 2021 hcpcs code for injection, ziv aflibercept, 1 mg or just inj, ziv aflibercept, 1mg for short, used in medical care. The key to maximizing the potential benefit of these agents is understanding where these new therapies fit in the overall scheme of treatment options and how to help patients. Overview zaltrap is a recombinant fusion protein consisting of vascular endothelial growth factor vegf receptors 1 and 2 fused to.
Eylea with ndc 61755005 is a a human prescription drug product labeled by regeneron pharmaceuticals, inc the generic name of eylea is aflibercept. Reviews, revisions, and approvals date approval date policy split from cp. It is a fully humanized recombinant fusion protein that acts as a soluble receptor to bind vascular endothelial growth factor vegfa, vegfb, and placental growth factors 1 and 2, which prevents other native receptors from binding. Aflibercept, sold under the brand names eylea and zaltrap, is a medication used to treat wet macular degeneration and metastatic colorectal cancer. The cancer medications enquiry database canmed is a twopart resource for cancer drug treatment related studies. Section 604 lists level ii hcpcs codes that are payable under masshealth.
Fda approved indications zaltrap, in combination with 5fluorouracil, leucovorin, irinotecan folfiri, is indicated for patients with metastatic colorectal cancer crc that is resistant to or has progressed following an oxaliplatincontaining regimen. Drug name hcpcs code drug name hcpcs code erwinase asparginase j9019 sylvant siltuximab j2860 ethyol amifostine j0207 treanda bendamustine j9033 granix tbofilgrastim j1447 vectibix panitumumab j9303 halaven eribulin mesylate j9179 yervoy ipilimumab j9228 herceptin trastuzumab j9355 zaltrap ziv aflibercept j9400 imfinzi. Ziv aflibercept aflibercept is a recombinant fusion protein which combines the portions of human vascular endothelial growth factor receptors extracellular domains fused to the fc portion of human igg1. Ziv aflibercept is used with other medications to treat cancer of the colon and rectum. In august 2012, ziv aflibercept became eligible for medicare reimbursement. Apr 01, 2021 hcpcs brand name generic name mandatory distribution through magellan rx specialty pharmacy j7314 yutiq fluocinolone acetonide j9400 zaltrap ziv aflibercept j0256 zemaira alpha1proteinase inhibitor human j9223 zepzelca lurbinectedin q5120 ziextenzo pegfilgrastinbmez j0565 zinplava bezlotoxumab. Access to this feature is available in the following products. Hcpcs medication codes requiring prior authorization select. Medical oncology program for bcn hmosm commercial members effective august 1, 2019 blue care network manages medical oncology and supportive care drugs.
Ziv aflibercept zaltrap type of submission check all that apply. For example, if the description for the hcpcs code specifies 50 milligrams mg. Zivaflibercept is a drug used in combination with other chemotherapy drugs to treat metastatic colorectal cancer. Zivaflibercept systemic professional patient advice.
J9400 is a valid 2021 hcpcs code for injection, zivaflibercept, 1 mg or just inj, zivaflibercept, 1mg for short, used in medical care. Coverage of gene therapies is not addressed in this. Hcpcs code brand name generic name effective date j9264. Hcps subject to prior authorization for uphp medicaid. Hcpcs code for injection, zivaflibercept, 1 mg j9400 hcpcs code j9400 for injection, zivaflibercept, 1 mg as maintained by cms falls under chemotherapy drugs. Please submit all supporting documents including labs, progress notes. Medicaid medical pharmacy prior authorized hcpcs codes author. J9400 ziv aflibercept zaltrap 812019 q5101 filgrastimsndz zarxio 812019. The patients were divided into 2 groups group 1, ziv aflibercept. This article is based on change request cr 8575 which describes updates to the healthcare common procedure coding system hcpcs and changes to and billing instructions for various. Department of health and human services supercoder.
Colorectal cancer that has metastasized spread to other parts of the body. Hcpcs jcode on a second line for wasted medication, if appropriate. Fda approved indications zaltrap, in combination with 5fluorouracil, leucovorin, irinotecan folfiri, is indicated for patients with metastatic colorectal cancer crc that is resistant to or has progressed following an. Fda approval of ziv aflibercept was based on a multinational, randomized, doubleblind, parallelarm, phase iii trial velour. Subscribe to codify and get the code details in a flash. Analytical comparability assessment on glycosylation of ziv. Discontinue ziv aflibercept at least 4 weeks prior to elective surgery. Ziv aflibercept is also being studied in the treatment of other types of cancer. Questions regarding coding and billing guidance should be submitted to the insurer in whose jurisdiction a claim would be filed. Drugs administered other than oral method, chemotherapy drugs. The nccn compendium is a derivative work of the nccn guidelines. The generic name usually includes the active ingredients of the product. Ziv aflibercept minimal emetic risk ziv aflibercept j9400. Page 2 of 2 ziv aflibercept will not be given concomitantly with cetuximab, panitumumab, or bevacizumab.
Zivaflibercept zaltrap medical clinical policy bulletins. It binds vegfa, vegfb, and placental growth factor 4 r. Hcpcs j9400 injection, ziv aflibercept, 1 mg 1 twodigit numeric codes are level i code modifiers ed by the american medical associations current procedural terminology cpt. Dosage package size package quantity billable units billable units pkg. Hcpcs code for injection, ziv aflibercept, 1 mg j9400 hcpcs code j9400 for injection, ziv aflibercept, 1 mg as maintained by cms falls under chemotherapy drugs. It is a highly sialylated glycoprotein with 5 nglycosylation sites. Ziv aflibercept will not be given concomitantly with cetuximab, panitumumab, or bevacizumab. J codes are a subset of the hcpcs level ii code set used to primarily identify injectable drugs. C9296 injection, zivaflibercept, 1 mg healthcare common.
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