Coding Rationale As of Jan. 1, 2019, the Healthcare Common Procedure Coding System (HCPCS) code for rituximab was changed from J9310 rituximab 100 mg, to the new HCPCS code J9312 (injection, rituximab, 100 mg).
The RUXIENCE HCPCS code Q5119 is described as “Injection, rituximab-pvvr, biosimilar, (Ruxience), 10 mg.” Each dose increment of 10 milligrams equals 1 billing unit.
HCPCS code J9312 for Injection, rituximab, 10 mg as maintained by CMS falls under Chemotherapy Drugs.
HCPCS code Q5115 for Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg as maintained by CMS falls under Cancer Treatment Drugs .
RUXIENCE is a mAb biosimilar to Rituxan which works by targeting a protein called CD20, which is present on the surface of B cells. When it attaches to CD20, rituximab helps destroy the B cells.
Rituximab-Pvvr Injection, for Intravenous Use (Ruxience™) HCPCS Code J9999: Billing Guidelines.
Rituximab (Rituxan) HCPCS code J9310 Rituximab, 100 mg, injection: Billing Guidelines.
Effective January 1, 2019 J-code J9312 will replace J9310 for RITUXAN and the billable units will change from 100 mg to 10 mg. Additionally, the permanent J-code assigned for RITUXAN HYCELA is J9311. The RITUXAN AND RITUXAN HYCELA J-Code Flash Card, attached to this email, details the new J-code information.
Meloxicam Injection, for Intravenous Use (Anjeso™) HCPCS Code J3490: Billing Guidelines.
HCPCS code Q5108 for Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg as maintained by CMS falls under Anti-Inflammatory Medication and Chemotherapy Medication.
Bevacizumab-Bvzr Injection, for Intravenous Use (Zirabev™) HCPCS Code Q5118 - Injection, Bevacizumab-Bvzr, Biosimilar, (Zirabev), 10 mg: Billing Guidelines.
HCPCS code Q5117 for Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg as maintained by CMS falls under Cancer Treatment Drugs .
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Title XVIII of the Social Security Act, §1862 (a) (1) (A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Title XVIII of the Social Security Act, §1861 (t) (2) (B) Drugs and Biologicals Title XVIII of the Social Security Act, §1862 (a) (1) (D) Investigational or Experimental CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §§50, 50.1, 50.4.1, 50.4.2, 50.4.3, and 50.4.5 Drugs and Biologicals.
Rituximab is a genetically engineered chimeric murine/human monoclonal IgG1 kappa antibody directed against the CD20 antigen." Rituximab binds specifically to the antigen CD20 (human B-lymphocyte-restricted differentiation antigen, Bp35), a hydrophobic transmembrane protein with a molecular weight of approximately 35 kD located on pre-B and mature B lymphocytes.
Rituximab, in combination with methotrexate, is covered to reduce signs and symptoms in adult patients with moderately to severely active RA who have had an inadequate response to one or more tumor necrosis factor (TNF) antagonist therapies. Chronic Lymphocytic Leukemia (CLL)
Rituximab is covered for the treatment of patients with previously untreated follicular, CD20-positive, B-Cell NHL in combination with first-line chemotherapy and – in patients achieving a complete or partial response to rituximab in combination with chemotherapy – as a single-agent maintenance therapy. Rituximab is covered for the treatment of ...
Rituximab is covered for the treatment of patients with previously untreated diffuse large B-Cell, CD20-positive NHL in combination with cyclophosphamide, doxorubicine, vincristine, and prednisone (CHOP) or other anthracycline-based chemotherapy regimens.
Medicaid and NCHC cover Rituximab for the following FDA-approved indications: Rituximab is covered for the treatment of patients with relapsed or refractory, low-grade or follicular, CD20-positive, B-Cell non-Hodgkin’s lymphoma as a single agent.
Categories Z40-Z53 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, or care to consolidate the treatment, or to deal with a residual state. Type 2 Excludes.
Z79.02 Long term (current) use of antithrombotics/an... Z79.1 Long term (current) use of non-steroidal anti... Z79.2 Long term (current) use of antibiotics. Z79.3 Long term (current) use of hormonal contracep... Z79.4 Long term (current) use of insulin.