Welcome. Coding uidelines Coding Guidelines Coding. Coding Guidelines Coding Guidelines. Contact Us. Edition #1 March 2018

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Coding Guidelines Coding Guidelines uidelines Coding Guidelines Coding Coding Coding Guidelines Guidelines Coding uidelines Coding Guidelines Coding Coding Chemotherapy

Chemotherapy and Radiation Therapy codes and corresponding descriptions and categories (listed by CPT/HCPCS).

If you have any questions about these codes, please contact us as indicated below. Working together, we can improve health outcomes for your Today s Options patients!

1 Coding Guidelines Coding Guidelines uidelines Coding Guidelines Coding Coding Coding Guidelines Guidelines Coding uidelines Coding Guidelines Coding Coding Chemotherapy Guidelines and Radiation Coding Therapy Guidelines Categories Edition #1 March 2018 Welcome These Coding Guidelines are designed to provide you with a quick-view of Chemotherapy and Radiation Therapy codes and corresponding descriptions and categories (listed by CPT/HCPCS). We encourage you to keep this tool handy, and hope that it will help to save you some time during the course of your workday. If you have any questions about these codes, please contact us as indicated below. Working together, we can improve health outcomes for your Today s Options patients! Contact Us Y0067_PR_TO_ChemoCodng_0218 WellCare 2018 We hope you find this coding information to be helpful. If you have any questions or need additional support, please contact your Provider Relations Representative or visit our Provider Resource Center at

Authorization Chemotherapy/Radiation Categories by CPT/HCPCS* CPT/HCPCS MODIFIER DESCRIPTION PPO/HMO 2018 19296 Place po breast cath for rad Radiation Therapy 19298 Place breast rad tube/caths

2 Authorization Chemotherapy/Radiation Categories by CPT/HCPCS* CPT/HCPCS MODIFIER DESCRIPTION PPO/HMO Place po breast cath for rad Radiation Therapy Place breast rad tube/caths Radiation Therapy Ins mark thor for rt perq Radiation Therapy Insertion of infusion pump Chemotherapy Drugs Revision of infusion pump Chemotherapy Drugs Removal of infusion pump Chemotherapy Drugs Insertion catheter artery Chemotherapy Drugs Insertion of cannula(s) Chemotherapy Drugs Ins mark abd/pel for rt perq Radiation Therapy Insert tun ip cath perc Chemotherapy Drugs Insert tun ip cath w/port Chemotherapy Drugs Instll rx agnt into rnal tub Chemotherapy Drugs Treatment of bladder lesion Chemotherapy Drugs Transperi needle place pros Radiation Therapy Place rt device/marker pros Radiation Therapy Place needles pelvic for rt Radiation Therapy Insert uteri tandem/ovoids Radiation Therapy Ins vag brachytx device Radiation Therapy Insert heyman uteri capsule Radiation Therapy Implt brain chemotx add-on Chemotherapy Drugs TC Echograp trans r pros study Radiation Therapy Echograp trans r pros study Radiation Therapy TC Echo guidance radiotherapy Radiation Therapy Echo guidance radiotherapy Radiation Therapy Radiation therapy planning Radiation Therapy Radiation therapy planning Radiation Therapy Radiation therapy planning Radiation Therapy TC Set radiation therapy field Radiation Therapy Set radiation therapy field Radiation Therapy TC Set radiation therapy field Radiation Therapy Set radiation therapy field Radiation Therapy TC Set radiation therapy field Radiation Therapy Set radiation therapy field Radiation Therapy TC Respirator motion mgmt simul Radiation Therapy Respirator motion mgmt simul Radiation Therapy TC 3-d radiotherapy plan Radiation Therapy d radiotherapy plan Radiation Therapy TC Radiation therapy planning Radiation Therapy Radiation therapy planning Radiation Therapy TC Radiation therapy dose plan Radiation Therapy Radiation therapy dose plan Radiation Therapy TC Radiotherapy dose plan imrt Radiation Therapy Radiotherapy dose plan imrt Radiation Therapy TC Telethx isodose plan simple Radiation Therapy *Note: Codes are subject to change per policy updates. Today s Options PPO/HMO 2 TC = Technical Component

3 77306 Telethx isodose plan simple Radiation Therapy TC Telethx isodose plan cplx Radiation Therapy Telethx isodose plan cplx Radiation Therapy TC Brachytx isodose plan simple Radiation Therapy Brachytx isodose plan simple Radiation Therapy TC Brachytx isodose intermed Radiation Therapy Brachytx isodose intermed Radiation Therapy TC Brachytx isodose complex Radiation Therapy Brachytx isodose complex Radiation Therapy TC Special teletx port plan Radiation Therapy Special teletx port plan Radiation Therapy TC Special radiation dosimetry Radiation Therapy Special radiation dosimetry Radiation Therapy TC Radiation treatment aid(s) Radiation Therapy Radiation treatment aid(s) Radiation Therapy TC Radiation treatment aid(s) Radiation Therapy Radiation treatment aid(s) Radiation Therapy TC Radiation treatment aid(s) Radiation Therapy Radiation treatment aid(s) Radiation Therapy Radiation physics consult Radiation Therapy TC Design mlc device for imrt Radiation Therapy Design mlc device for imrt Radiation Therapy Radiation physics consult Radiation Therapy Srs multisource Radiation Therapy Srs linear based Radiation Therapy Sbrt delivery Radiation Therapy TC External radiation dosimetry Radiation Therapy External radiation dosimetry Radiation Therapy Radiation treatment delivery Radiation Therapy Radiology port film(s) Radiation Therapy Neutron beam tx simple Radiation Therapy Neutron beam tx complex Radiation Therapy Io rad tx delivery by x-ray Radiation Therapy Io rad tx deliver by elctrns Radiation Therapy Radiation tx management x5 Radiation Therapy Radiation therapy management Radiation Therapy Stereotactic radiation trmt Radiation Therapy Sbrt management Radiation Therapy Io radiation tx management Radiation Therapy TC Special radiation treatment Radiation Therapy Special radiation treatment Radiation Therapy TC Radiation therapy management Radiation Therapy Radiation therapy management Radiation Therapy Proton trmt simple w/o comp Radiation Therapy Proton trmt simple w/comp Radiation Therapy Proton trmt intermediate Radiation Therapy Proton treatment complex Radiation Therapy TC Hyperthermia treatment Radiation Therapy Hyperthermia treatment Radiation Therapy TC Hyperthermia treatment Radiation Therapy Today s Options PPO/HMO 3 TC = Technical Component

4 77605 Hyperthermia treatment Radiation Therapy TC Hyperthermia treatment Radiation Therapy Hyperthermia treatment Radiation Therapy TC Hyperthermia treatment Radiation Therapy Hyperthermia treatment Radiation Therapy TC Hyperthermia treatment Radiation Therapy Hyperthermia treatment Radiation Therapy TC Infuse radioactive materials Radiation Therapy Infuse radioactive materials Radiation Therapy TC Apply intrcav radiat simple Radiation Therapy Apply intrcav radiat simple Radiation Therapy TC Apply intrcav radiat interm Radiation Therapy Apply intrcav radiat interm Radiation Therapy TC Apply intrcav radiat compl Radiation Therapy Apply intrcav radiat compl Radiation Therapy TC Hdr rdncl skn surf brachytx Radiation Therapy Hdr rdncl skn surf brachytx Radiation Therapy TC Hdr rdncl skn surf brachytx Radiation Therapy Hdr rdncl skn surf brachytx Radiation Therapy TC Hdr rdncl ntrstl/icav brchtx Radiation Therapy Hdr rdncl ntrstl/icav brchtx Radiation Therapy TC Hdr rdncl ntrstl/icav brchtx Radiation Therapy Hdr rdncl ntrstl/icav brchtx Radiation Therapy TC Hdr rdncl ntrstl/icav brchtx Radiation Therapy Hdr rdncl ntrstl/icav brchtx Radiation Therapy TC Apply interstit radiat compl Radiation Therapy Apply interstit radiat compl Radiation Therapy TC Apply surface radiation Radiation Therapy Apply surface radiation Radiation Therapy TC Radiation handling Radiation Therapy Radiation handling Radiation Therapy TC Radium/radioisotope therapy Radiation Therapy Radium/radioisotope therapy Radiation Therapy Spin/brain pump refil & main Chemotherapy Drugs Spin/brain pump refil & main Chemotherapy Drugs Ther/proph/diag iv inf init Chemotherapy Drugs Ther/proph/diag iv inf addon Chemotherapy Drugs Tx/proph/dg addl seq iv inf Chemotherapy Drugs Ther/diag concurrent inf Chemotherapy Drugs Sc ther infusion up to 1 hr Chemotherapy Drugs Sc ther infusion addl hr Chemotherapy Drugs Sc ther infusion reset pump Chemotherapy Drugs Tx/pro/dx inj same drug adon Chemotherapy Drugs Chemo anti-neopl sq/im Chemotherapy Drugs Chemo hormon antineopl sq/im Chemotherapy Drugs Chemo intralesional up to 7 Chemotherapy Drugs Chemo intralesional over 7 Chemotherapy Drugs Chemo iv push sngl drug Chemotherapy Drugs Chemo iv push addl drug Chemotherapy Drugs Chemo iv infusion 1 hr Chemotherapy Drugs Today s Options PPO/HMO 4 TC = Technical Component

5 96415 Chemo iv infusion addl hr Chemotherapy Drugs Chemo prolong infuse w/pump Chemotherapy Drugs Chemo iv infus each addl seq Chemotherapy Drugs Chemo ia push tecnique Chemotherapy Drugs Chemo ia infusion up to 1 hr Chemotherapy Drugs Chemo ia infuse each addl hr Chemotherapy Drugs Chemotherapy infusion method Chemotherapy Drugs Chemotherapy intracavitary Chemotherapy Drugs Chemotx admn prtl cavity Chemotherapy Drugs Chemotherapy into cns Chemotherapy Drugs Refill/maint portable pump Chemotherapy Drugs Refill/maint pump/resvr syst Chemotherapy Drugs Irrig drug delivery device Chemotherapy Drugs Chemotherapy injection Chemotherapy Drugs Chemotherapy unspecified Chemotherapy Drugs C1714 Catheter, transluminal atherectomy, directional Radiation Therapy C1715 Brachytherapy needle Radiation Therapy C1716 Brachytherapy source, non-stranded, gold-198, per source Radiation Therapy C1717 Brachytherapy source, non-stranded, high dose rate iridium-192, per source Radiation Therapy C1719 Brachytherapy source, non-stranded, non-high dose rate iridium-192, per source Radiation Therapy C1728 Catheter, brachytherapy seed administration Radiation Therapy C2616 Brachytherapy source, non-stranded, yttrium-90, per source Radiation Therapy C2634 Brachytherapy source, non-stranded, high activity, iodine-125, greater than... Radiation Therapy C2635 Brachytherapy source, non-stranded, high activity, paladium-103, greater th... Radiation Therapy C2636 Brachytherapy linear source, non-stranded, paladium-103, per 1 mm Radiation Therapy C2637 Brachytherapy source, non-stranded, ytterbium-169, per source Radiation Therapy C2638 Brachytherapy source, stranded, iodine-125, per source Radiation Therapy C2639 Brachytherapy source, non-stranded, iodine-125, per source Radiation Therapy C2640 Brachytherapy source, stranded, palladium-103, per source Radiation Therapy C2641 Brachytherapy source, non-stranded, palladium-103, per source Radiation Therapy C2642 Brachytherapy source, stranded, cesium-131, per source Radiation Therapy C2643 Brachytherapy source, non-stranded, cesium-131, per source Radiation Therapy C2698 Brachytherapy source, stranded, not otherwise specified, per source Radiation Therapy C2699 Brachytherapy source, non-stranded, not otherwise specified, per source Radiation Therapy C9725 Placement of endorectal intracavitary applicator for high intensity brachyt... Radiation Therapy C9726 Placement and removal (if performed) of applicator into breast for intraope... Radiation Therapy C9728 Placement of interstitial device(s) for radiation therapy/surgery guidance... Radiation Therapy G0339 Robot lin-radsurg com, first Radiation Therapy G0340 Robt lin-radsurg fractx 2-5 Radiation Therapy Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with G0498 continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion Chemotherapy Drugs G6001 Echo guidance radiotherapy Radiation Therapy G6002 Stereoscopic x-ray guidance Radiation Therapy G6003 Radiation treatment delivery Radiation Therapy G6004 Radiation treatment delivery Radiation Therapy G6005 Radiation treatment delivery Radiation Therapy G6006 Radiation treatment delivery Radiation Therapy Today s Options PPO/HMO 5 TC = Technical Component

6 G6007 Radiation treatment delivery Radiation Therapy G6008 Radiation treatment delivery Radiation Therapy G6009 Radiation treatment delivery Radiation Therapy G6010 Radiation treatment delivery Radiation Therapy G6011 Radiation treatment delivery Radiation Therapy G6012 Radiation treatment delivery Radiation Therapy G6013 Radiation treatment delivery Radiation Therapy G6014 Radiation treatment delivery Radiation Therapy G6015 Radiation tx delivery imrt Radiation Therapy G6016 Delivery comp imrt Radiation Therapy G6017 Intrafraction track motion Radiation Therapy J0897 Denosumab injection Chemotherapy Drugs J1459 Inj ivig privigen 500 mg Chemotherapy Drugs J1557 Gammaplex injection Chemotherapy Drugs J1561 Gamunex-c/gammaked Chemotherapy Drugs J1566 Immune globulin, powder Chemotherapy Drugs J1568 Octagam injection Chemotherapy Drugs J1569 Gammagard liquid injection Chemotherapy Drugs J1572 Flebogamma injection Chemotherapy Drugs J8498 Antiemetic rectal/supp nos Chemotherapy Drugs J8501 Oral aprepitant Chemotherapy Drugs J8510 Oral busulfan Chemotherapy Drugs J8520 Capecitabine, oral, 150 mg Chemotherapy Drugs J8521 Capecitabine, oral, 500 mg Chemotherapy Drugs J8530 Cyclophosphamide oral 25 mg Chemotherapy Drugs J8540 Oral dexamethasone Chemotherapy Drugs J8560 Etoposide oral 50 mg Chemotherapy Drugs J8562 Oral fludarabine phosphate Chemotherapy Drugs J8597 Antiemetic drug oral nos Chemotherapy Drugs J8600 Melphalan oral 2 mg Chemotherapy Drugs J8610 Methotrexate oral 2.5 mg Chemotherapy Drugs J8650 Nabilone oral Chemotherapy Drugs J8655 Netupitant palonosetron oral Chemotherapy Drugs J8655 Netupitant 300 mg and palonosetron 0.5 mg Chemotherapy Drugs J8670 Rolapitant, oral, 1 mg Chemotherapy Drugs J8700 Temozolomide Chemotherapy Drugs J8705 Topotecan oral Chemotherapy Drugs J8999 Oral prescription drug chemo Chemotherapy Drugs J9000 Doxorubicin hcl injection Chemotherapy Drugs J9015 Aldesleukin injection Chemotherapy Drugs J9017 Arsenic trioxide injection Chemotherapy Drugs J9019 Erwinaze injection Chemotherapy Drugs J9020 Asparaginase, nos Chemotherapy Drugs J9022 Inj, atezolizumab,10 mg Chemotherapy Drugs J9023 Injection, avelumab, 10 mg Chemotherapy Drugs J9025 Azacitidine injection Chemotherapy Drugs J9027 Clofarabine injection Chemotherapy Drugs J9031 Bcg live intravesical vac Chemotherapy Drugs J9032 Injection, belinostat, 10mg Chemotherapy Drugs J9032 Injection, belinostat, 10 mg Chemotherapy Drugs Today s Options PPO/HMO 6 TC = Technical Component

7 J9033 Bendamustine injection Chemotherapy Drugs J9034 Injection, bendamustine hcl (bendeka), 1 mg Chemotherapy Drugs J9035 Bevacizumab injection Chemotherapy Drugs J9039 Injection, blinatumomab Chemotherapy Drugs J9039 Injection, blinatumomab, 1 microgram Chemotherapy Drugs J9040 Bleomycin sulfate injection Chemotherapy Drugs J9041 Bortezomib injection Chemotherapy Drugs J9042 Brentuximab vedotin inj Chemotherapy Drugs J9043 Cabazitaxel injection Chemotherapy Drugs J9045 Carboplatin injection Chemotherapy Drugs J9047 Injection, carfilzomib, 1 mg Chemotherapy Drugs J9050 Carmustine injection Chemotherapy Drugs J9055 Cetuximab injection Chemotherapy Drugs J9060 Cisplatin 10 mg injection Chemotherapy Drugs J9065 Inj cladribine per 1 mg Chemotherapy Drugs J9070 Cyclophosphamide 100 mg inj Chemotherapy Drugs J9098 Cytarabine liposome inj Chemotherapy Drugs J9100 Cytarabine hcl 100 mg inj Chemotherapy Drugs J9120 Dactinomycin injection Chemotherapy Drugs J9130 Dacarbazine 100 mg inj Chemotherapy Drugs J9145 Injection, daratumumab, 10 mg Chemotherapy Drugs J9150 Daunorubicin injection Chemotherapy Drugs J9151 Daunorubicin citrate inj Chemotherapy Drugs J9155 Degarelix injection Chemotherapy Drugs J9160 Denileukin diftitox inj Chemotherapy Drugs J9165 Diethylstilbestrol injection Chemotherapy Drugs J9171 Docetaxel injection Chemotherapy Drugs J9175 Elliotts b solution per ml Chemotherapy Drugs J9176 Injection, elotuzumab, 1 mg Chemotherapy Drugs J9178 Inj, epirubicin hcl, 2 mg Chemotherapy Drugs J9179 Eribulin mesylate injection Chemotherapy Drugs J9181 Etoposide injection Chemotherapy Drugs J9185 Fludarabine phosphate inj Chemotherapy Drugs J9190 Fluorouracil injection Chemotherapy Drugs J9200 Floxuridine injection Chemotherapy Drugs J9201 Gemcitabine hcl injection Chemotherapy Drugs J9202 Goserelin acetate implant Chemotherapy Drugs J9203 Gemtuzumab ozogamicin 0.1 mg Chemotherapy Drugs J9205 Injection, irinotecan liposome, 1 mg Chemotherapy Drugs J9206 Irinotecan injection Chemotherapy Drugs J9207 Ixabepilone injection Chemotherapy Drugs J9208 Ifosfamide injection Chemotherapy Drugs J9209 Mesna injection Chemotherapy Drugs J9211 Idarubicin hcl injection Chemotherapy Drugs J9212 Interferon alfacon-1 inj Chemotherapy Drugs J9213 Interferon alfa-2a inj Chemotherapy Drugs J9214 Interferon alfa-2b inj Chemotherapy Drugs J9215 Interferon alfa-n3 inj Chemotherapy Drugs J9216 Interferon gamma 1-b inj Chemotherapy Drugs J9217 Leuprolide acetate suspnsion Chemotherapy Drugs Today s Options PPO/HMO 7 TC = Technical Component

8 J9218 Leuprolide acetate injeciton Chemotherapy Drugs J9219 Leuprolide acetate implant Chemotherapy Drugs J9225 Vantas implant Chemotherapy Drugs J9226 Supprelin la implant Chemotherapy Drugs J9228 Ipilimumab injection Chemotherapy Drugs J9230 Mechlorethamine hcl inj Chemotherapy Drugs J9245 Inj melphalan hydrochl 50 mg Chemotherapy Drugs J9250 Methotrexate sodium inj Chemotherapy Drugs J9260 Methotrexate sodium inj Chemotherapy Drugs J9261 Nelarabine injection Chemotherapy Drugs J9262 Inj, omacetaxine mep, 0.01mg Chemotherapy Drugs J9263 Oxaliplatin Chemotherapy Drugs J9264 Paclitaxel protein bound Chemotherapy Drugs J9266 Pegaspargase injection Chemotherapy Drugs J9267 Paclitaxel injection Chemotherapy Drugs J9268 Pentostatin injection Chemotherapy Drugs J9270 Plicamycin (mithramycin) inj Chemotherapy Drugs J9271 Inj pembrolizumab Chemotherapy Drugs J9271 Injection, pembrolizumab, 1 mg Chemotherapy Drugs J9280 Mitomycin injection Chemotherapy Drugs J9285 Inj, olaratumab, 10 mg Chemotherapy Drugs J9293 Mitoxantrone hydrochl / 5 mg Chemotherapy Drugs J9295 Injection, necitumumab, 1 mg Chemotherapy Drugs J9299 Injection, nivolumab Chemotherapy Drugs J9299 Injection, nivolumab, 1 mg Chemotherapy Drugs J9301 Obinutuzumab inj Chemotherapy Drugs J9302 Ofatumumab injection Chemotherapy Drugs J9303 Panitumumab injection Chemotherapy Drugs J9305 Pemetrexed injection Chemotherapy Drugs J9306 Injection, pertuzumab, 1 mg Chemotherapy Drugs J9307 Pralatrexate injection Chemotherapy Drugs J9308 Injection, ramucirumab Chemotherapy Drugs J9308 Injection, ramucirumab, 5 mg Chemotherapy Drugs J9310 Rituximab injection Chemotherapy Drugs J9315 Romidepsin injection Chemotherapy Drugs J9320 Streptozocin injection Chemotherapy Drugs J9325 Injection, talimogene laherparepvec, per 1 million plaque forming units Chemotherapy Drugs J9328 Temozolomide injection Chemotherapy Drugs J9330 Temsirolimus injection Chemotherapy Drugs J9340 Thiotepa injection Chemotherapy Drugs J9351 Topotecan injection Chemotherapy Drugs J9352 Injection, trabectedin, 0.1 mg Chemotherapy Drugs J9354 Inj, ado-trastuzumab emt 1mg Chemotherapy Drugs J9355 Trastuzumab injection Chemotherapy Drugs J9357 Valrubicin injection Chemotherapy Drugs J9360 Vinblastine sulfate inj Chemotherapy Drugs J9370 Vincristine sulfate 1 mg inj Chemotherapy Drugs J9371 Inj, vincristine sul lip 1mg Chemotherapy Drugs Today s Options PPO/HMO 8 TC = Technical Component

9 J9390 Vinorelbine tartrate inj Chemotherapy Drugs J9395 Injection, fulvestrant Chemotherapy Drugs J9400 Inj, ziv-aflibercept, 1mg Chemotherapy Drugs J9600 Porfimer sodium injection Chemotherapy Drugs J9999 Chemotherapy drug Chemotherapy Drugs Q0083 Chemo by other than infusion Chemotherapy Drugs Q0084 Chemotherapy by infusion Chemotherapy Drugs Q0085 Chemo by both infusion and o Chemotherapy Drugs Q0161 Chlorpromazine hcl 5mg oral Chemotherapy Drugs Q0162 Ondansetron oral Chemotherapy Drugs Q0163 Diphenhydramine hcl 50mg Chemotherapy Drugs Q0164 Prochlorperazine maleate 5mg Chemotherapy Drugs Q0166 Granisetron hcl 1 mg oral Chemotherapy Drugs Q0167 Dronabinol 2.5mg oral Chemotherapy Drugs Q0169 Promethazine hcl 12.5mg oral Chemotherapy Drugs Q0173 Trimethobenzamide hcl 250mg Chemotherapy Drugs Q0174 Thiethylperazine maleate10mg Chemotherapy Drugs Q0175 Perphenazine 4mg oral Chemotherapy Drugs Q0177 Hydroxyzine pamoate 25mg Chemotherapy Drugs Q0180 Dolasetron mesylate oral Chemotherapy Drugs Q0181 Unspecified oral anti-emetic Chemotherapy Drugs Q0477 Pwr module pt cable lvad rpl Chemotherapy Drugs Q2043 Sipuleucel-t auto cd54+ Chemotherapy Drugs Q3001 Brachytherapy radioelements Radiation Therapy Today s Options PPO/HMO 9 TC = Technical Component

Primary malignant neoplasms, not lymphatic or hematopoietic. Secondary malignant neoplasms (i.e.metastatic) Malignant neoplasm, unknown site

Supplementary Table 1. ICD-9-CM codes used to define cancer ICD-9 Diagnosis code 140.xx-172.xx 174.xx-195.xx 196.xx 198.xx 199.xx 200.xx-208.xx Description Primary malignant neoplasms, not lymphatic or