Leukemia. Treatment of. compendia. Associated ICD-9-CM Codes: Drug & Administration. managedcareoncology.com

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Drug & compendia Treatment of Leukemia With each publication, Managed Care Oncology s Drug & Compendia highlights a single medication or a group of medications that could be utilized in the

This section addresses such topics as: Associated ICD-9-CM codes (includes FDA-approved 1 and Compendia-approved 2 indications) Possible medication(s) used to treat the conditions, including

1 Drug & compendia Treatment of Leukemia With each publication, Managed Care Oncology s Drug & Compendia highlights a single medication or a group of medications that could be utilized in the management of one of the featured oncology diseases. This section addresses such topics as: Associated ICD-9-CM codes (includes FDA-approved 1 and Compendia-approved 2 indications) Possible medication(s) used to treat the conditions, including ancillary medication(s) Reimbursement and coding information (how to bill for new medications) HCPCS/ codes and code description Current code price (AWP-based pricing) Most recent Medicareallowable Possible administration codes that can be utilized with each medication Associated ICD-9-CM s: Plasma cell Plasmacytic 204 Lymphoid Includes : lymphatic lymphoblastic lymphocytic lymphogenous The following fifth-digit subclassification is for use with category : 0 without mention of having achieved remission > Failed remission < 1 in remission 2 in relapse Acute Excludes acute exacerbation of chronic lymphoid (204.1) Chronic Subacute Other lymphoid Aleukemic : lymphatic lymphocytic lymphoid Unspecified lymphoid 205 Myeloid Includes : granulocytic myeloblastic myleocytic myelogenous myelomonocytic myelosclerotic myelosis Acute Acute promyelocytic Excludes acute exacerbation of chronic myeloid (205.1) Chronic Eosinophilic Neutrophilic Subacute Myeloid sarcoma Chloroma Granulocytic sarcoma Other myeloid Aleukemic : granulocytic myelogenous myeloid Aleukemic myelosis Unspecified myeloid 206 Monocytic Includes : histiocytic monoblastic monocytoid Acute Excludes acute exacerbation of chronic monocytic (206.1) Chronic Subacute Other monocytic Aleukemic: monocytic monocytoid Unspecified monocytic 207 Other specified Excludes leukemic reticuloendotheliosis (202.4) Plasma cell (203.1) Acute erythremia and erythro Acute erythremic myelosis Di Guglielmo s disease Erythremic myelosis Chronic erythremia Heilmeyer- Schöner disease Megakaryocytic Megakaryocytic myelosis Thrombocytic Other specified Lymphosarcoma cell 208 Leukemia of unspecified cell type Acute Acute NOS Stem cell Blast cell Excludes acute exacerbation of chronic unspecified (208.1) Chronic Chronic NOS Subacute Subacute NOS Other of unspecified cell type Unspecified Leukemia NOS managedcareoncology.com 33

2 Medications Currently Available to Treat Leukemia HCPCS / Current Price Current Price (AWP-based pricing) (s) A9563 sodium phosphate P-32 1 Sodium phosphate P-32, therapeutic, per millicurie 5/1/2008 $ N/A AWP minus 5% $347.56/mL J3487 zoledronic acid (Zometa) 2 J7506 prednisone 1 zoledronic acid (Zometa), 1 mg Prednisone, oral, per 5 mg 11/1/2008 $ $ , /1/2009 $0.06 $0.04 N/A J8510 busulfan (Myleran) 1 Busulfan, oral, 2 mg 10/1/2008 $3.88 $2.91 N/A J8530 cyclophosphamide (Cytoxan) 1 Cyclophosphamide, oral, 25 mg 2/1/2009 $2.09 $0.92 N/A J8540 Dexamethasone, oral, 0.25 mg 11/29/2005 $0.11 $0.37 N/A dexamethasone (Decadron) 1 J8610 methotrexate 1 J9000 doxorubicin HCl (Adriamycin) 1 J9010 alemtuzumab (Campath) 1 J9017 arsenic trioxide (Trisenox) 1 J9020 asparaginase (Elspar) 1 J9025 azacitidine (Vidaza) 1 J9027 clofarabine (Clolar) 1 J9033 bendamustine HCl (Treanda) 1 J9065 cladribine (Leustatin) 1 J9090 cyclophosphamide (Cytoxan) 1 J9091 cyclophosphamide (Cytoxan) 1 J9092 cyclophosphamide (Cytoxan) 1 J9100 cytarabine 1 J9110 cytarabine 1 J9150 daunorubicin (Cerubidine) 1 Methotrexate, oral, 2.5 mg doxorubicin HCl, 10 mg alemtuzumab, 10 mg arsenic trioxide, 1 mg asparaginase, 10,000 units azacitidine, 1 mg clofarabine, 1 mg bendamustine HCl, 1 mg cladribine, per 1 mg Cyclophosphamide, 500 mg Cyclophosphamide, 1 g Cyclophosphamide, 2 g cytarabine, 100 mg cytarabine, 500 mg daunorubicin, 10 mg 9/10/2003 $3.56 $0.16 N/A 8/7/2003 $13.75 $ /1/2009 $ $ , 12/1/2008 $45.40 $ , 12/1/2007 $69.86 $ , /1/2008 $5.69 $ , 96409, /1/2006 $ $ , 12/1/2008 $22.50 $ /30/2004 $60.63 $ , 10/1/2008 $31.60 $ , 96413, 12/1/2008 $56.90 $ , 96413, 5/1/2008 $52.50 $ , 96413, 5/1/2001 $3.75 $ , 96413,, /20/2003 $10.63 $ , 96413,, /1/2008 $26.25 $ , managedcareoncology Quarter

3 HCPCS / Current Price Current Price (AWP-based pricing) (s) J9185 fludarabine phosphate (Fludara) 1 J9211 idarubicin HCl (Idamycin) 1 J9214 interferon, alfa-2b (Intron-A) 1 J9230 mechlorethamine HCl (Mustargen) 1 fludarabine phosphate, 50 mg idarubicin HCl, 5 mg interferon, alfa-2b, recombinant, 1 million units mechlorethamine HCl (nitrogen mustard), 10 mg 9/22/2003 $ $ /1/2009 $ $ /1/2009 $21.93 $ , /1/2008 $ $ J9250 Methotrexate sodium, 5 mg 11/1/2007 $0.24 $ , 96374, methotrexate sodium , 96409, J9260 Methotrexate sodium, 50 mg 11/1/2007 $2.38 $ , 96374, methotrexate sodium , 96409, J9261 nelarabine, 50 mg 10/1/2008 $ $ , nelarabine (Arranon) 1 J9266 pegaspargase (Oncaspar) 1 pegaspargase, per single dose vial 2/1/2008 $3, $2, , 96413, J9268 pentostatin, per 10 mg 9/1/2007 $2, $1, , pentostatin (Nipent) 1 J9293 mitoxantrone HCl (Novantrone) 1 J9300 gemtuzumab ozogamicin (Mylotarg) 1 mitoxantrone HCl, per 5 mg gemtuzumab ozogamicin, 5 mg 10/1/2008 $ $ , /1/2008 $3, $2, , J9310 rituximab, 100 mg 11/1/2008 $ $ , rituximab (Rituxan) 2 J9370 Vincristine sulfate, 1 mg 9/1/2005 $10.00 $ vincristine sulfate (Vincaspar PFS) 1 J9375 vincristine sulfate (Vincaspar PFS) 1 Vincristine sulfate, 2 mg 9/1/2005 $20.00 $ J9380 Vincristine sulfate, 5 mg 9/1/2005 $50.00 $ vincristine sulfate (Vincaspar PFS) 1 Q2017 teniposide, 50 mg 10/1/2008 $ $ , teniposide (Vumon) 1 S0088 Imatinib, 100 mg 2/1/2009 $41.82 N/A see NDC level imatinib (Gleevec) 1 pricing below S0108 Mercaptopurine, oral, 50 mg 2/12/2004 $4.09 N/A see NDC level mercaptopurine (Purinethol) 1 pricing below S0172 Chlorambucil, oral, 2 mg 10/1/2008 $3.36 N/A see NDC level chlorambucil (Leukeran) 1 pricing below S0176 Hydroxyurea, oral, 500 mg 1/1/2009 $1.28 N/A see NDC level hydroxyurea (Hydrea) 1 pricing below N/A N/A N/A N/A managedcareoncology.com 35

4 Additional Nonclassified Medications Available to Treat Leukemia (These medications have not been assigned a permanent HCPCS J- by CMS) J8999: Prescription drug, oral, chemotherapeutic, not otherwise specified** / Strength NDC (National Drug ) AWP AWP/Unit (WAC or WAC + 106%) (s) chlorambucil (Leukeran) 1 /2 mg dasatinib (Sprycel) 1 /20 mg dasatinib (Sprycel) 1 /50 mg dasatinib (Sprycel) 1 /70 mg dasatinib (Sprycel) 1 /100 mg hydroxyurea (Hydrea) 1 /500 mg mercaptopurine (Purinethol) 1 /50 mg nilotinib (Tasigna) 1 /200 mg nilotinib (Tasigna) 1 /200 mg thioguanine (Tabloid) 1 /40 mg /3/2008 $3.36/tab $2.69/tab N/A /1/2009 $62.73/tab $53.20/tab N/A /1/2009 $125.47/tab $106.39/tab N/A /1/2009 $125.47/tab $106.39/tab N/A /1/2009 $250.93/tab $212.80/tab N/A /5/2008 $1.52/cap $1.22/cap N/A /3/2008 $5.80/tab $4.64/tab N/A /6/2009 $70.36/cap $59.67/cap N/A /6/2009 $70.36/cap $59.67/cap N/A /3/2008 $8.60/cap $6.88/tab N/A ** When billing a nonclassified medication using a CMS 1500 claim form, you must include both the HCPCS code (i.e., J8999 for Leukeran) in Column 24D and the drug name, strength, and NDC (National Drug ) in Box 19 in order to ensure appropriate reimbursement. Ancillary Medications Used in Cancer Treatment HCPCS / Current Price Current Price (AWP-based pricing) (s) J1626 granisetron (Kytril) J2405 ondansetron (Zofran) J2469 palonosetron (Aloxi) J8501 aprepitant (Emend) granisetron HCl, 100 mcg 10/1/2008 $10.61 $ ondansetron HCl, per 1 mg 5/1/2008 $0.63 $ , palonosetron HCl, 25 mcg 1/1/2009 $42.75 $ Aprepitant, oral, 5 mg 9/1/2007 $6.60 $5.36 N/A Q0166 granisetron (Kytril) Granisetron HCl, oral, 1 mg, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment, not to exceed a 24-hour dosage regimen 5/1/2008 $59.00 $16.58 N/A 36 managedcareoncology Quarter

5 HCPCS / Current Price Current Price (AWP-based pricing) (s) Q0179 ondansetron (Zofran) S0091 granisetron (Kytril) S0181 ondansetron (Zofran) Ondansetron HCl, oral, 8 mg, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment, not to exceed a 48-hour dosage regimen (code price is per 8 mg) Granisetron HCl, 1 mg (for circumstances falling under the Medicare statute, use Q0166) Ondansetron HCl, oral, 4 mg (for circumstances falling under the Medicare statute, use Q0179) 2/1/2009 $39.36 $3.33 N/A 5/1/2008 $59.00 N/A N/A 2/1/2009 $24.09 N/A N/A s Chemotherapy administration, subcutaneous or intramuscular; nonhormonal antineoplastic Chemotherapy administration, subcutaneous or intramuscular; hormonal antineoplastic Chemotherapy administration; intravenous, push technique, single or initial substance/drug Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure.) (Use in conjunction with and ) Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure.) (Use in conjunction with ) Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than eight hours), requiring use of a portable or implantable pump Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to one hour (List separately in addition to code for primary procedure.) (Use in conjunction with ) Chemotherapy administration, into CNS (e.g., intrathecal), requiring and including spinal puncture Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to one hour Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single, or initial substance/drug Insertion, nonbiodegradable drug delivery implant Removal, nonbiodegradable drug delivery implant Removal with reinsertion, nonbiodegradable drug delivery implant Bladder instillation of anticarcinogenic agent (including retention time) Radiopharmaceutical therapy, by intravenous administration Leukemia References HCPCS Level II Expert 2009 Current Procedural Terminology () 2009 ICD-9-CM for Professionals Volumes 1 and 2, 2009 The Drug Reimbursement Coding and Pricing Guide by R J Health Systems International LLC, Volume 6, Number 1, First Quarter FDA-approved indication (product prescribing information) 2 NCCN (National Comprehensive Cancer Network) powered by R J Health Systems International, LLC, Wethersfield, Conn. CMS (Centers for Medicare & Medicaid Services) First Quarter 2009 s 1/1/09 This information was supplied by R J Health Systems International, LLC, located in Wethersfield, Conn. Prices listed herein are effective as of February 13, managedcareoncology.com 37

6 Oncology-Related HCPCS s This reference chart will assist the Oncology Office (Office Manager, Oncology Nurse, Physician, and Ancillary Staff) and payor with the appropriate codes to utilize when billing or reimbursing for medication(s). HCPCS / (s) J0881 darbepoetin alfa (Aranesp) darbepetin alfa, 1 mcg (non- ESRD use) Anemia in chronic kidney disease (285.21) Anemia in neoplastic disease (285.22) Anemia, unspecified (285.9) Encounter for antineoplastic chemotherapy (V58.11) Low-grade myelodysplastic syndrome lesions (238.72) High-grade myelodysplastic syndrome lesions (238.73) Myelodysplastic syndrome with 5q deletion (238.74) Myelodysplastic syndrome, unspecified (238.75) Other specified aplastic anemias (284.89) $6.02 9/1/2008 $ J0885 epoetin alfa (Procrit, Epogen) epoetin alfa (for non-esrd use), 1,000 units Anemia in chronic kidney disease (285.21) Anemia in neoplastic disease (285.22) Anemia, unspecified (285.9) Encounter for antineoplastic chemotherapy (V58.11) Anemia of other chronic disease (285.29) Low-grade myelodysplastic syndrome lesions (238.72) High-grade myelodysplastic syndrome lesions (238.73) Myelodysplastic syndrome with 5q deletion (238.74) Myelodysplastic syndrome, unspecified (238.75) Other specified aplastic anemias (284.89) $ /1/2009 $ J0894 decitabine (Dacogen) decitabine, 1 mg Low-grade myelodysplastic syndrome lesions (238.72) High-grade myelodysplastic syndrome lesions (238.73) Myelodysplastic syndrome with 5q deletion (238.74) Myelodysplastic syndrome, unspecified (238.75) N/A $ /1/2009 $ J1440 (300 mcg) filgrastim (Neupogen) filgrastim (G-CSF), 300 mcg Neutropenia, unspecified (288.00) Congenital neutropenia (288.01) Cyclic neutropenia (288.02) Drug-induced neutropenia (288.03) Neutropenia due to infection (288.04) Other neutropenia (288.09) Hemophagocytic syndromes (288.4) Leukocytopenia, unspecified (288.50) Lymphocytopenia (288.51) Other decreased white blood cell count (288.59) Neutropenic splenomegaly (289.53) Encounter for antineoplastic chemotherapy (V58.11) Convalescence and palliative care following chemotherapy (V66.2) Low-grade myelodysplastic syndrome lesions (238.72) High-grade myelodysplastic syndrome lesions (238.73) Myelodysplastic syndrome with 5q deletion (238.74) Myelodysplastic syndrome, unspecified (238.75) $ /1/2008 $ managedcareoncology Quarter

7 HCPCS / (s) J1441 (480 mcg) filgrastim (Neupogen) filgrastim (G-CSF), 480 mcg Neutropenia, unspecified (288.00) Congenital neutropenia (288.01) Cyclic neutropenia (288.02) Drug-induced neutropenia (288.03) Neutropenia due to infection (288.04) Other neutropenia (288.09) Hemophagocytic syndromes (288.4) Leukocytopenia, unspecified (288.50) Lymphocytopenia (288.51) Other decreased white blood cell count (288.59) Neutropenic splenomegaly (289.53) Encounter for antineoplastic chemotherapy (V58.11) Convalescence and palliative care following chemotherapy (V66.2) Low-grade myelodysplastic syndrome lesions (238.72) High-grade myelodysplastic syndrome lesions (238.73) Myelodysplastic syndrome with 5q deletion (238.74) Myelodysplastic syndrome, unspecified (238.75) $ /1/2008 $ J2505 pegfilgrastim (Neulasta) pegfilgrastim, 6 mg Neutropenia, unspecified (288.00) Congenital neutropenia (288.01) Cyclic neutropenia (288.02) Drug-induced neutropenia (288.03) Neutropenia due to infection (288.04) Other neutropenia (288.09) Hemophagocytic syndromes (288.4) Leukocytopenia, unspecified (288.50) Lymphocytopenia (288.51) Other decreased white blood cell count (288.59) Neutropenic splenomegaly (289.53) N/A $3, /1/2008 $2, J3315 triptorelin pamoate (Trelstar Depot, Trelstar LA) triptorelin pamoate, 3.75 mg of prostate (185) N/A $ /1/2008 $ managedcareoncology.com 39

8 HCPCS / (s) J9055 cetuximab (Erbitux) cetuximab, 10 mg of colon (153._) of rectum, rectosigmoid junction, and anus (154._) of lip (140._) tongue (141._) major salivary glands (142._) of gum (143._) floor of mouth (144._) other and unspecified parts of mouth (145._) oropharynx (146._) of nasopharynx (147._) of hypopharynx (148._) other and ill-defined sites within the lip, oral cavity, and pharynx (149._) nasal cavities, middle ear, and accessory sinuses (160._) of larynx (161._) other and ill-defined sites head, face, and neck (195.0) other and unspecified parts of mouth (145._) rectum, rectosigmoid junction, and anus rectosigmoid junction (154.0) rectum, rectosigmoid junction, and anus rectum (154.1) rectum, rectosigmoid junction, and anus other (154.8) trachea, bronchus, and lung (162._) Other malignant neoplasm of skin skin of lip (173.0) Secondary and unspecified malignant neoplasm of lymph nodes lymph nodes of head, face, and neck (196.0) Neoplasm of uncertain behavior of digestive and respiratory systems lip, oral cavity, and pharynx (235.1) Neoplasm of uncertain behavior of digestive and respiratory systems larynx (235.6) $ /1/2005 $ managedcareoncology Quarter

9 HCPCS / (s) J9170 docetaxel (Taxotere) docetaxel, 20 mg trachea, bronchus, and lung (162._) female breast (174._) male breast (175._) prostate (185) lip (140._) tongue (141._) gum (143._) floor of mouth (144._) other and unspecified parts of mouth (145._) oropharynx (146._) nasopharynx (147._) hypopharynx (148._) other and ill-defined sites within the lip, oral cavity, and pharynx (149._) esophagus (150._) stomach (151._) retroperitoneum and peritoneum (158._) larynx (161._) connective and other soft tissue head, face, and neck (171.0) connective and other soft tissue upper limb, including shoulder (171.2) connective and other soft tissue lower limb, including hip (171.3) connective and other soft tissue abdomen (171.5) connective and other soft tissue other specified sites of connective and other soft tissue (171.8) connective and other soft tissue connective and other soft tissue, site unspecified (171.9) Other malignant neoplasm of skin skin of lip (173.0) cervix uteri (180._) ovary and other uterine adnexa (183._) prostate (185) bladder (188._) kidney and other and unspecified urinary organs renal pelvis (189.1) kidney and other and unspecified urinary organs ureter (189.2) Secondary and unspecified malignant neoplasm of lymph nodes Lymph nodes of head, face, and neck (196.0) without specification of site disseminated (199.0) without specification of site other (199.1) Carcinoma in situ of breast and genitourinary system bladder (233.7) Neoplasm of uncertain behavior of digestive and respiratory systems lip, oral cavity, and pharynx (235.1) Neoplasm of uncertain behavior of digestive and respiratory systems larynx (235.6) Neoplasm of uncertain behavior of other and unspecified sites and tissues connective and other soft tissue (238.1) Neoplasms of unspecified nature (239._) $ /1/2009 $ managedcareoncology.com 41

10 HCPCS / (s) J9202 goserelin acetate (Zoladex) Goserelin acetate implant, per 3.6 mg female breast (174._) male breast (175._) prostate (185) Endometriosis (617._) Disorders of menstruation and other abnormal bleeding from female genital tract other (626.8) N/A $ /27/2000 $ J9206 irinotecan HCl (Camptosar) irinotecan, 20 mg of colon (153._) of rectum, rectosigmoid junction, and anus (154._) esophagus (150._) stomach (151._) trachea, bronchus, and lung (162._) cervix uteri (180._) ovary and other uterine adnexa (183._) brain (191._) $ /1/2008 $ J9218 leuprolide acetate (Lupron) Leuprolide acetate, per 1 mg of prostate (185) female breast (174._) male breast (175._) ovary and other uterine adnexa (183._) $ /1/2006 $ J9225 histrelin implant (Vantas) Histrelin implant (Vantas), 50 mg of prostate (185) N/A $6, /1/2008 $1, J9263 oxaliplatin (Eloxatin) oxaliplatin, 0.5 mg of colon (153._) rectum, rectosigmoid junction, and anus (154._) esophagus (150._) stomach (151._) pancreas head of pancreas (157.0) pancreas body of pancreas (157.1) pancreas tail of pancreas (157.2) pancreas pancreatic duct (157.3) pancreas other specified sites of pancreas (157.8) pancreas pancreas, part unspecified (157.9) ovary and other uterine adnexa (183._) testis (186._) Marginal zone lymphoma ( ) Mantle cell lymphoma ( ) Large cell lymphoma ( ) Nodular lymphoma ( ) Other lymphomas ( ) $ /1/2008 $ J9264 paclitaxel proteinbound particles (Abraxane) paclitaxel protein-bound particles, 1 mg female breast (174._) male breast (175._) trachea, bronchus, and lung (162._) $ /1/2009 $ managedcareoncology Quarter

11 HCPCS / (s) J9265 paclitaxel (Onxol, Taxol) paclitaxel, 30 mg Onxol female breast (174._) male breast (175._) ovary and other uterine adnexa (183._) Taxol trachea, bronchus, and lung (162._) female breast (174._) male breast (175._) Kaposi s sarcoma (176._) ovary and other uterine adnexa (183._) Taxol lip (140._) tongue (141._) gum (143._) other and unspecified parts of mouth (145._) oropharynx (146._) nasopharynx (147._) hypopharynx (148._) other and ill-defined sites within the lip, oral cavity, and pharynx (149._) esophagus (150._) stomach (151._) retroperitoneum and peritoneum retroperitoneum (158.0) retroperitoneum and peritoneum specified parts of peritoneum (158.8) nasal cavities, middle ear, and accessory sinus maxillary sinus (160.2) nasal cavities, middle ear, and accessory sinus ethmoidal sinus (160.3) larynx (161._) thymus, heart, and mediastinum thymus (164.0) connective and other soft tissue head, face, and neck (171.0) connective and other soft tissue upper limb, including shoulder (171.2) connective and other soft tissue lower limb, including hip (171.3) connective and other soft tissue abdomen (171.5) connective and other soft tissue connective and other soft tissue, site unspecified (171.9) Malignant melanoma of skin (172._) Other malignant neoplasm of skin skin of lip (173.0) cervix uteri (180._) body of uterus (182._) prostate (185) testis (186._) bladder (188._) kidney and other and unspecified urinary organs renal pelvis (189.1) kidney and other and unspecified urinary organs ureter (189.2) Secondary and unspecified malignant neoplasm of lymph nodes lymph nodes of head, face, and neck (196.0) without specification of site disseminated (199.0) without specification of site other (199.1) Benign neoplasm of respiratory and intrathoracic organs thymus (212.6) Carcinoma in situ of breast and genitourinary system bladder (233.7) Neoplasm of uncertain behavior of digestive and respiratory systems lip, oral cavity, and pharynx (235.1) Neoplasm of uncertain behavior of digestive and respiratory systems larynx (235.6) Neoplasms of unspecified nature (239._) $ /1/2008 $ managedcareoncology.com 43

12 HCPCS / (s) J9303 panitumumab (Vectibix) panitumumab, 10 mg colon (153._) rectum, rectosigmoid junction, and anus (154._) N/A $ /1/2008 $ J9305 pemetrexed disodium (Alimta) pemetrexed, 10 mg trachea, bronchus, and lung (162._) pleura (163._) thymus, heart, and mediastinum thymus (164.0) bladder (188._) kidney and other and unspecified urinary organs renal pelvis (189.0) kidney and other and unspecified urinary organs ureter (189.2) Benign neoplasm of respiratory and intrathoracic organs thymus (212.6) Carcinoma in situ of breast and genitourinary system bladder (233.7) $ /1/2009 $ J9355 trastuzumab (Herceptin) Trastuzumab, 10 mg female breast (174._) male breast (175._) N/A $ /1/2008 $ ** The code price is based on the HCPCS code description. HCPCS (Healthcare Common Procedure Coding System) codes are a component of CMS (Centers for Medicare & Medicaid Services). The code price is an AWP-based pricing methodology developed by R J Health Systems International, LLC, Wethersfield, Conn. Oncology-Related J- References HCPCS Level II Expert 2009 Current Procedural Terminology () 2009 NCCN (National Comprehensive Cancer Network) Compendia-approved uses American Medical Association. Professional ICD-9-CM 2009 Volumes 1 and 2, AMA Press, 2009 Full prescribing information for each drug listed The Drug Reimbursement Coding and Pricing Guide by R J Health Systems International, LLC, Volume 6, Number 1, First Quarter powered by R J Health Systems International, LLC, Wethersfield, Conn. CMS (Centers for Medicare & Medicaid Services) First Quarter s 1/1/09 44 managedcareoncology Quarter

Medications currently available to treat Multiple Myeloma include: Current Code Price (AWP) Effective Date. Code Price (AWP)

Medications currently available to treat Multiple Myeloma include: Current Code Price (AWP) Effective Date. Code Price (AWP) drug and administration compendia Compendia information developed and maintained by With each publication Managed Care Oncology s Drug & Compendia will highlight a single medication or a group of medications