Hcpcs code brand name generic name effective date j9264. Drugs administered other than oral method, chemotherapy drugs. C9296 injection, ziv aflibercept, 1 mg k2 j1744 injection, icatibant, 1 mg k2 j2212 injection, methylnaltrexone, 0. It could also provide a second line of therapy in eyes with wet amd or dme resistant to. 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. Zaltrap zivaflibercept injection for intravenous infusion zaltrap may be identified by a healthcare common procedure coding system hcpcs level ii code and by a national drug code ndc. 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. Renewal criteria1,2 coverage can be renewed based upon the following criteria. Ziv aflibercept is used with other medications to treat cancer of the colon and rectum. Ziv aflibercept will be used in combination with an irinotecan based regimen.
This code description may also have includes, excludes, notes, guidelines, examples and other information. Mar 19, 2021 ndc proprietary name nonproprietary name dosage form route name company name product type. 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. Mt included healthcon 2021 and code book and exam prep dos and.
This detailed description can be identified in an hcpcs coding book. National comprehensive cancer network, nccn, and nccn guidelines are trademarks owned by the national comprehensive cancer network, inc. Bestcorrected visual acuity bcva in snellen and logarithm of minimum angle of resolution logmar, central. Injection, zivaflibercept, 1 mg j9400 hcpcs codes codify. 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. Ziv aflibercept minimal emetic risk ziv aflibercept j9400. For example, if the description for the hcpcs code specifies 50 milligrams mg. The optum hcpcs level ii book provides colored symbols for each coverage and reimbursement instruction. Analytical comparability assessment on glycosylation of. It is used in patients whose disease has not gotten better with other chemotherapy.
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. 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. This crosswalk is intended to help the public understand which drug products identified by ndcs are assigned to which hcpcs billing. Hcpcs code j9400 for injection, ziv aflibercept, 1 mg as maintained by cms. 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.
Department of health and human services supercoder. Access to this feature is available in the following products. 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. The patients were divided into 2 groups group 1, ziv aflibercept. Uphp keywords hcpcs, jcodes, pharmacy created date. The nccn compendium is a derivative work of the nccn guidelines.
It binds vegfa, vegfb, and placental growth factor 4 r. Ziv aflibercept zaltrap is a vascular endothelial growth factor vegf inhibitor. The generic name usually includes the active ingredients of the product. Please submit all supporting documents including labs, progress notes. The 2014 hcpcs updates new, revised, and discontinued.
Overview zaltrap is a recombinant fusion protein consisting of vascular endothelial growth factor vegf receptors 1 and 2 fused to. Medicaid medical pharmacy prior authorized hcpcs codes author. Zivaflibercept binds vegfa, b and plgf and has improved survival in refractory metastatic colorectal cancer. Zaltrap ziv aflibercept injection for intravenous infusion prior approval is required for some or all procedure codes listed in this corporate drug policy. Hcpcs code j9400 for injection, zivaflibercept, 1 mg as maintained by cms. Reviews, revisions, and approvals date approval date policy split from cp. Injection, leucovorin calcium, per 50 mg folinic acid j0641. J9395 hcpcs code for injection, fulvestrant, 25 mg. L0455, tlso, flexible, provides trunk support, extends from sacrococcygeal junction to above t9 vertebra. The cancer medications enquiry database canmed is a twopart resource for cancer drug treatment related studies. 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. Beginning in january 20, providers billed medicare using hcpcs code c9296. Department of health and human services centers for medicare.
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. Coding for injectable drugs american academy of ophthalmology. Coverage of gene therapies is not addressed in this. The medicare contractor for jurisdiction 1 overpaid a. It is an inhibitor of vascular endothelial growth factor vegf. Cpt codes, descriptors, and other data only are 2011 american medical association. Hcpcs medication codes requiring prior authorization select. J9400 ziv aflibercept zaltrap 812019 q5101 filgrastimsndz zarxio 812019. Fda approval of ziv aflibercept was based on a multinational, randomized, doubleblind, parallelarm, phase iii trial velour. Generic name brand name hcpcs code recent effective date eribulin halaven j9179 filgrastimsndz zarxio q5101 filgrastin neupogen j1442 galsulfase naglazyme j1458 may 1, 2017 golimumab simponi aria j1602.
Hcpcs codes description j9400 injection, ziv aflibercept, 1 mg. Hcpcs jcode on a second line for wasted medication, if appropriate. Full prescribing information, including boxed warning, clinical trial information, safety, dosing. And patient has received previous adjuvant folfox fluorouracil, leucovorin, and. Zivaflibercept zaltrap medical clinical policy bulletins. Colorectal cancer that has metastasized spread to other parts of the body. It is approved for the treatment of wet agerelated macular degeneration 5 s, 6 r and in combination with 5fluorouracil.
The use of na indicates that the hcpcs code was not available. Hcpcs code description j9400 injection, ziv aflibercept, 1mg. The recommended ziv aflibercept dose and schedule is 4 mgkg administered as a 60minute iv. Aflibercept is a drug used for the treatment of patients with agerelated macular degeneration. It is a highly sialylated glycoprotein with 5 nglycosylation sites. Providers are responsible for informing their billing agency of information in this bulletin. 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. Ziv aflibercept will not be given concomitantly with cetuximab, panitumumab, or bevacizumab.
J9400 is a valid 2021 hcpcs code for injection, zivaflibercept, 1 mg or just inj, zivaflibercept, 1mg for short, used in medical care. 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. 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. The nonproprietary name is sometimes called the generic name. Medical oncology program for bcn hmosm commercial members effective august 1, 2019 blue care network manages medical oncology and supportive care drugs. Each hcpcs code in this list must be accompanied by a valid ndc in the lin03 segment of the hipaa 837 transactoi n. Hcpcs generic name brand name effective date end date page 1 revised.
Hcpcs code for injection, zivaflibercept, 1 mg j9400 hcpcs code j9400 for injection, zivaflibercept, 1 mg as maintained by cms falls under chemotherapy drugs. Ziv aflibercept zaltrap type of submission check all that apply. In august 2012, ziv aflibercept became eligible for medicare reimbursement. Medicare prior authorization list snpmapdmmp absolute total. Drug name hcpcs code if known ziv aflibercept zaltrap j9400. Subscribe to codify and get the code details in a flash. Hcpcs generic name brand name effective end date date. A j code may cover the supply, injection or infusion of a drug or. Patient continues to meet indicationspecific relevant criteria such as concomitant therapy. Adult guidelines for assessment and management of nausea.
Questions regarding coding and billing guidance should be submitted to the insurer in whose jurisdiction a claim would be filed. Eylea with ndc 61755005 is a a human prescription drug product labeled by regeneron pharmaceuticals, inc the generic name of eylea is aflibercept. 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 was developed by regeneron pharmaceuticals and is approved in the united states and the european union. Ziv aflibercept may be initiated or resumed once the surgical wound is fully healed after minor surgery e. C9296 injection, zivaflibercept, 1 mg healthcare common. Cms administers part b and contracts with medicare. Beginning july 2012, providers billed medicare using hcpcs code q2046 and then changed to j0178 effective january 20. It was developed by regeneron pharmaceuticals and is approved in the united states and the european union it is.
The following codes should be utilized for billing. Analytical comparability assessment on glycosylation of ziv. 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. Zaltrap zivaflibercept dose, indications, adverse effects. Chlorpromazine hydrochloride, 10 mg, oral, fda approved prescription. Ziv aflibercept is approved to be used with folfiri to treat. For complete cpthcpcs code listing, please see online prior authorization tool on health plan website.
A legend to these symbols is provided on the bottom of each twopage spread. The medicare contractor for jurisdiction 1 overpaid a provider that. J9600 hcpcs code for injection, porfimer sodium, 75 mg. 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. 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. Medical oncology prior authorization list for uaw retiree. Ziv aflibercept will be given as a single line of therapy. 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. Injection, zivaflibercept, 1 mg j9400 hcpcs codes codify by. Successfully coding retina injectable drugs retina today. 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. In august 2012, zivaflibercept became eligible for medicare reimbursement but did not have an assigned hcpcs code. J codes are a subset of the hcpcs level ii code set used to primarily identify injectable drugs.
Injectable medications subject to medical necessity and. Zivaflibercept zaltrap ambetter from superior healthplan. Zivaflibercept is a drug used in combination with other chemotherapy drugs to treat metastatic colorectal cancer. Department of heathl care servcesi heatlhcare common. Drugs dispensed to a patient and immunizations are likely not covered by a j code. 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. Ndc pharmacologic class n0000193543 vascular endothelial.
Restricted access do not disseminate or copy without approval. J9400 hcpcs code for injection, zivaflibercept, 1 mg. For private sector health insurance systems, please contact the individual private insurance entity. 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. 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. Section 604 lists level ii hcpcs codes that are payable under masshealth. Ziv aflibercept is also being studied in the treatment of other types of cancer. Discontinue ziv aflibercept at least 4 weeks prior to elective surgery.
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. Overview zaltrap is a recombinant fusion protein consisting of vascular. Page 2 of 2 ziv aflibercept will not be given concomitantly with cetuximab, panitumumab, or bevacizumab. 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. Zivaflibercept systemic professional patient advice. Hcps subject to prior authorization for uphp medicaid.
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