drug and administration compendia Current Price () J7506 Prednisone, oral, per 5 mg 12/1/07 $0.07 $0.19 N/A prednisone 2 J8520 capecitabine (Xeloda) 1 Capecitabine, oral, 150 mg 8/1/07 $5.79 $4.59 N/A J8521 capecitabine (Xeloda) 1 Capecitabine, oral, 500 mg 8/1/07 $19.29 $15.21 N/A J8530 Cyclophosphamide, oral, 25 mg 9/1/06 $2.03 $0.86 N/A With each publication Managed Care Oncology s Drug & Compendia will highlight a single medication or a group of medications that could be utilized in the management of one of the featured oncology diseases. Associated ICD-9-CM s: 174 female breast Includes: breast (female), connective tissue, soft parts; Paget s disease of: breast, nipple; use additional code to identify estrogen receptor status (V86.0, V86.1) Excludes: skin of breast (172.5, 173.5) 174.0 Nipple and areola 174.1 Central portion 174.2 Upper-inner quadrant 174.3 Lower-inner quadrant 174.4 Upper-outer quadrant This section will address such topics as: Associated ICD-9-CM s (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) 174.5 Lower-outer quadrant 174.6 Axillary tail 174.8 Other specified sites of female breast Ectopic sites, Inner breast, Lower breast, contiguous or overlapping sites of breast whose point of origin cannot be determined, Midline of breast, Outer breast, Upper breast 174.9 Breast (female), unspecified Medications currently available to treat Breast Cancer include: HCPCS/CPT codes and description Current Based Pricing Most recent ASP Plus 6% () Possible s that can be utilized with each medication 175 male breast Use additional code to identify estrogen receptor status (V86.0, V86.1) Excludes: skin of breast (172.5, 173.5) 175.0 Nipple and areola 175.9 Other and unspecified sites of male breast Ectopic breast tissue, male J8540 dexamethasone (Decadron) 2 Dexamethasone, oral, 0.25 mg 11/29/05 $0.11 $0.25 N/A J8610 Methotrexate, oral, 2.5 mg 9/10/03 $3.56 $0.21 N/A methotrexate 1 J9000 doxorubicin (Adriamycin) 1 J9001 doxorubicin (Doxil) 2 J9035 bevacizumab (Avastin) 1 J9045 carboplatin (Paraplatin) 2 J9060 cisplatin (Platinol) 2 J9062 cisplatin (Platinol AQ) 2 J9090 J9091 J9092 Doxorubicin, HCl, 8/7/03 $13.75 $6.83 96409, 96411, 96413, Doxorubicin hydrochloride, all lipid formulations, 8/1/07 $513.13 $412.25 96409, 96411, 96413, bevacizumab, 1/1/05 $68.75 $57.46 96409, 96411, 96413, Carboplatin, 50 mg 9/1/07 $54.90 $7.05 96409, 96411, 96413, Cisplatin, powder or solution, per 1/1/08 $4.57 $2.55 96409, 96411, 96413, Cisplatin, 50 mg 1/1/08 $22.85 $12.75 96409, 96411, 96413, Cyclophosphamide, 500 mg 9/27/04 $15.80 $17.06 96409, 96411, 96413, Cyclophosphamide, 1.0 gm 9/27/04 $28.45 $18.90 96409, 96411, 96413, Cyclophosphamide, 2.0 gm 9/27/04 $51.20 $37.79 96409, 96411, 96413, Current Price () J9170 docetaxel (Taxotere) 1 Docetaxel, 20 mg 1/1/08 $432.78 $319.42 96409, 96411, 96413, J1190 dexrazoxane HCl (Zinecard) 1 dexrazoxane hydrochloride, per 250 mg 4/28/03 $256.54 $163.84 96409, 96411, 96413, J9178 epirubicin (Ellence) 1 epirubicin HCl, 2 mg 2/1/08 $28.25 $11.45 96409, 96411, 96413, J2430 pamidronate disodium (Aredia) 1 pamidronate disodium, per 30 mg 3/1/07 $101.60 $29.63 96409, 96411, 96413, J9190 fluorouracil (Adrucil) 1 Fluorouracil, 500 mg 7/1/07 $3.44 $1.81 96409, 96411, 96413, 28 managedcareoncology Quarter 1 2008 managedcareoncology.com 29
Current Price () Current Price () J9201 gemcitabine (Gemzar) 1 Gemcitabine HCl, 200 mg 2/1/08 $164.13 $131.65 96409, 96411, 96413, J9370 Vincristine sulfate, 9/1/05 $10.00 $7.73 96409, 96411, 96413, J9202 goserelin acetate (Zoladex) 1 J9208 ifosfamide (Ifex) 2 J9217 (Eligard, Lupron depot) 2 J9218 (Lupron) 2 J9219 (Viadur) 2 J9245 melphalan HCl (Alkeran) 2 J9250 methotrexate sodium 1 J9260 methotrexate sodium 1 J9264 paclitaxel (Abraxane) 1 J9265 paclitaxel (Taxol, Onxol) 1 Goserelin acetate implant, per 3.6 mg 1/27/00 $469.99 $191.86 96409, 96411, 96413, Ifosfamide, 1 g 7/1/07 $65.66 $35.55 96409, 96411, 96413, Leuprolide acetate (for depot suspension), 7.5 mg 5/1/06 $258.75 $242.79 96409, 96411, 96413, Leuprolide acetate, per 6/1/06 $27.45 $7.75 96409, 96411, 96413, Leuprolide acetate implant, 65 mg 5/18/01 $5,684.00 $1,714.87 96409, 96411, 96413, melphalan hydrochloride, 50 mg 2/1/07 $1,881.53 $1,563.63 96409, 96411, 96413, Methotrexate sodium, 5 mg 11/1/07 $0.24 $0.27 96409, 96411, 96413, Methotrexate sodium, 50 mg 11/1/07 $2.38 $2.74 96409, 96411, 96413, paclitaxel protein-bound particles, 2/1/08 $10.47 $8.87 96409, 96411, 96413, Paclitaxel, 30 mg 2/1/08 $51.68 $13.58 96409, 96411, 96413, J9375 J9380 J9390 vinorelbine (Navelbine) 2 J9395 fulvestrant (Faslodex) 1 S0156 exemestane (Aromasin) 1 S0170 anastrozole (Arimidex) 1 S0178 lomustine (CeeNu) 2 S0179 megestrol acetate (Megace) 1 S0187 tamoxifen (Nolvadex) 1 Vincristine sulfate, 2 mg 9/1/05 $20.00 $15.46 96409, 96411, 96413, Vincristine sulfate, 5 mg 9/1/05 $50.00 $38.66 96409, 96411, 96413, Vinorelbine tartrate, per 11/7/05 $94.00 $18.86 96409, 96411, 96413, fulvestrant, 25 mg 2/1/07 $99.35 $81.37 96409, 96411, 96413, Exemestane, 25 mg 2/1/08 $10.96 N/A N/A Anastrozole, oral, 2/1/07 $9.66 N/A N/A Lomustine, oral, 1/1/08 $10.31 N/A N/A Megestrol acetate, oral, 20 mg 4/1/07 $0.66 N/A N/A Tamoxifen citrate, oral, 2/20/03 $1.89 N/A N/A J9280 J9290 J9291 J9293 mitoxantrone HCl (Novantrone) 2 J9340 thiotepa 1 (Thioplex) J9355 trastuzumab (Herceptin) 1 Mitomycin, 5 mg 10/1/01 $70.00 $15.06 96409, 96411, 96413, Mitomycin, 20 mg 5/1/07 $340.21 $60.26 96409, 96411, 96413, Mitomycin, 40 mg 12/1/01 $878.48 $120.51 96409, 96411, 96413, mitoxantrone hydrochloride, per 5 mg 11/1/07 $227.08 $105.14 96409, 96411, 96413, Thiotepa, 15 mg 11/1/05 $97.82 $41.21 96409, 96411, 96413, Trastuzumab, 11/1/07 $72.05 $59.02 96409, 96411, 96413, Additional Non-Classified Medications (These medications have not been assigned a permanent HCPCS J- by CMS) J8999: Prescription drug, oral, chemotherapeutic, Not Otherwise Specified** NDC (National Drug ) Allowable) lapatinib ditosylate 00173-0752-00 3/14/07 $24.17/tab $20.49/tab N/A (Tykerb), 250 mg 1 letrozole (Femara), 00078-0249-15 1/3/08 $11.82/tab $10.01/tab N/A 2.5 mg 1 testolactone (Teslac), 00003-0690-50 1/2/04 $2.66/tab $2.26/tab N/A 50 mg 1 s J9360 vinblastine 1 (Velban) Vinblastine sulfate, 12/1/01 $3.31 $1.07 96409, 96411, 96413, toremifene citrate (Fareston), 60 mg 1 11399-0005-01, 11399-005-30 5/12/07 $5.16/tab $4.38/tab N/A 30 managedcareoncology Spring Quarter 2007 1 2008 managedcareoncology.com 31
References J8499: Prescription drug, oral, non-chemotherapeutic, Not Otherwise Specified ** NDC (National Drug ) Allowable) estradiol (Estrace), multiple 12/17/07 $1.74 $1.82 N/A 0.5 mg 1 estradiol (Estrace), multiple 12/17/07 $1.74 $1.82 N/A 1mg 1 estradiol (Estrace), multiple 12/17/07 $2.24 $1.90 N/A 2mg 1 s J9999**Not Otherwise Classified, antineoplastic drugs [Note: C9240 can be used for OPPS (Hospital Outpatient Billing), effective 1/1/08 Price is $76.83 and Ambulatory Payment Classification (APC) Rate effective 1/1/08 is $64.54] NDC (National Drug ) Allowable) - s ixabepilone (Ixempra), 00015-1910-12 10/17/07 $1,152.45/kit $977.28/kit 96409, 96411, 96413, 15 mg 1,, iixabepilone (Ixempra), 00015-1911-13 10/17/07 $3,457.36/kit $2,931.84/kit 96409, 96411, 96413, 45 mg 1,, ** When billing with a CMS 1500 claim form you must include both the HCPCS code (i.e., J8999 for Tykerb or J9999 for Ixempra) in Column 24D and the NDC (National Drug ) in Box 19 in order to ensure appropriate reimbursement. Ancillary Medications used in Cancer Treatment J2469 palonosetron (Aloxi) J1626 Q0166 S0091 J2405 ondansetron (Zofran) Q0179 ondansetron (Zofran) S0181 ondansetron (Zofran) J8501 aprepitant (Emend) palonosetron HCl, 25 mcg granisetron hydrochloride, 100 mcg Granisetron hydrochloride, 1mg oral, 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 Granisetron hydrochloride, (for circumstances falling under the Medicare statute, use Q0166) ondansetron hydrochloride, per 1mg Ondansetron hydrochloride 8mg, oral, 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 ( price is per 8 mg) Ondansetron HCl, oral, 4 mg (for circumstances falling under the Medicare statute, use Q0179) Current Price () 4/1/07 $39.84 $16.64 90765, 90774 2/1/08 $10.82 $4.72 90765, 90774 2/1/08 $59.01 $50.22 N/A 2/1/08 $59.01 N/A N/A 12/1/07 $0.75 $0.28 90765 12/1/07 $39.36 $9.17 N/A 1/1/08 $23.98 N/A N/A Aprepitant, oral, 5 mg 9/1/07 $6.60 $5.23 N/A HCPCS Level II Expert 2008. Current Procedural Terminology (CPT) 2008. ICD-9-CM for Professional Volumes 1 & 2 2008. The Drug Reimbursement Coding and Pricing Guide by R J Health Systems International, LLC Volume 5, Number 1, 1st Quarter 2008. 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) J0881 darbepoetin alfa (Aranesp) J0885 epoetin alfa (Procrit, Epogen) J0894 decitabine (Dacogen) J1440 (300 mcg) (Neupogen) darbepoetin alfa, 1 microgram (non-esrd use) epoetin alfa, (for non- ESRD use), 1000 units decitabine, (G-CSF), 300 mcg Anemia in chronic kidney disease (285.21) Anemia in neoplastic disease (285.22) Anemia, unspecified (285.9) Anemia in chronic kidney disease (285.21) Anemia in neoplastic disease (285.22) Anemia, unspecified (285.9), Other decreased white blood cell count (288.59) Convalescence and palliative care- Following chemotherapy (V66.2) 1 FDA-approved indication (Product prescribing information) 2 Compendia approved indication (Drug Points by Thomson Micromedex) www.reimbursements.com powered by R J Health Systems International LLC Price**/ N/A $5.79 Anemia of other chronic disease (285.29), Other lymphatic and hematopoietic tissues (238.79) (205.0) Myeloid leukemia (205._) Monocytic leukemia (206._) Other specified leukemia (207._) Leukemia of unspecified cell type-acute (208.0_), Other lymphatic and hematopoietic tissues (238.79) $15.16 $30.72 10/1/2007 $252.63 CMS (Centers for Medicare and Medicaid Services) 1st Quarter s 1/1/08-3/31/08 The information contained was supplied by R J Health Systems International LLC located in Wethersfield, Connecticut. Prices listed herein are effective as of February 25, 2008. $2.89 90772 $8.96 90772 $27.11 96413 $199.04 90765 90774 32 managedcareoncology Spring Quarter 2007 1 2008 managedcareoncology.com 33
Price**/ Price**/ J1441 (480 mcg) (Neupogen) J1645 dalteparin sodium (Fragmin) J2505 peg (Neulasta) (G-CSF), 480 mcg dalteparin sodium, per 2,500 IU eg, 6 mg Other decreased white blood cell count (288.59) Convalescence and palliative care- Following chemotherapy (V66.2) Acute myocardial infarction (410._) Intermediate coronary syndrome (411.1) Phlebitis and thrombophlebitis-of deep vessels of lower extremities (451.1_) Phlebitis and thrombophlebitis Of deep veins of upper extremities (451.83) of lower extremity (453.4_) of lower extremity Of other specified veins (453.8) of lower extremity Of unspecified site (453.9) Other decreased white blood cell count (288.59) Myeloid leukemia (205._) Monocytic leukemia (206._) Other specified leukemia (207._) Leukemia of unspecified cell type-acute (208.0_), Other lymphatic and hematopoietic tissues (238.79) $402.38 N/A $21.37 N/A $3,557.50 $305.39 90765 90774 $11.17 90772 $2,191.41 90772 J3315 triptorelin pamoate (Trelstar Depot, Trelstar LA) J3487 zoledronic acid (Zometa) J9025 azacitidine (Vidaza) J9041 bortezomib (Velcade) J9050 carmustine (BiCNU) J9055 cetuximab (Erbitux) triptorelin pamoate, 3.75 mg zoledronic acid (Zometa), azacitidine, bortezomib, 0. Carmustine, 100 mg cetuximab, prostate (185) Hypercalcemia (275.42) Bone and bone marrow (198.5), Other lymphomas (Mantle Cell Lymphoma) (202.80) brain (191._) Hodgkin s disease (201. ) reticulosarcoma and other specified malignant tumors of lymphatic tissue (200. ) colon lip (140._) tongue (141._) major salivary glands (142._) 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._) nasal cavities, middle ear, and accessory sinuses (160._) larynx (161._) Head, face, and neck (195.0) N/A $606.25 3/17/2005 Disorder of bone and cartilage, unspecified (733.90) (205.0) $261.43 $5.26 5/1/2007 $42.57 colon Other lymphomas (202.8_) Malignant melanoma of skin (172._) Malignant neoplasm of stomach (151._) pancreas (157._) $200.25 1/1/2008 $60.00 1/1/2005 $146.72 96402 $208.76 96413 $4.39 96413 96401 $34.44 96409 $153.79 96413 $49.79 96413 34 managedcareoncology Spring Quarter 2007 1 2008 managedcareoncology.com 35
J9065 cladribine (Leustatin) J9120 dactinomycin (Cosmegen) J9150 daunorubicin (Cerubidine) cladribine, per Dactinomycin, 0.5 mg Daunorubicin, Leukemic reticuloendotheliosis (202.4_) bone and articular cartilage (170._) connective and other soft tissue (171._) testis (186._) Other and unspecified testis (186.9) placenta (181) Neoplasm of uncertain behavior of genitourinary organs Placenta (236.1) unspecified urinary organs- Kidney, except pelvis (189.0) Lymphoid leukemia Acute (205.0_) Lymphoid leukemia Chronic (204.1_) Mycosis fungoides (202.1_) Sezary s disease (202.2_) Other lymphomas (202.8_) reticulosarcoma and other specified malignant tumors of lymphatic tissue (200. ) Nodular lymphoma (202.0_) Malignant histiocytosis (202.3_) Letterer-Siwe disease (202.5_) Malignant mast cell tumors (202.6_) Peripheral T-cell lymphoma (202.7_) Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue (202.9_) Lymphoid leukemia acute Kaposi s sarcoma (176._) Secondary malignant neoplasm of other specified sites Bone and bone marrow (198.5) ovary (183._) bone and articular cartilage (170._) nasal cavities, middle ear, and accessory sinuses (160._) other endocrine glands and related structures - Adrenal gland (194.0) reticulosarcoma and other specified malignant tumors of lymphatic tissue (200. ) unspecified urinary organs Kidney, except pelvis (189.0) Myeloid leukemia Chronic (205.1_) Price**/ $60.63 8/30/2004 $593.75 1/24/2006 $88.44 12/1/2001 $33.66 96413 $493.43 96413 $19.95 96413 J9200 floxuridine (FUDR) J9206 irinotecan hydrochloride (Camptosar) J9211 idarubicin (Idamycin) J9225 histerlin implant (Vantas) J9263 oxaliplatin (Eloxatin) J9266 pegaspargase (Oncaspar) J9303 panitumumab (Vectibix) J9305 pemetrexed disodium (Alimta) J9310 rituximab (Rituxan) Floxuridine, 500 mg Irinotecan, 20 mg Idarubicin hydrochloride, 5 mg Histrelin implant (Vantas), 50 mg oxaliplatin, 0.5 mg Pegaspargase, per single dose vial panitumumab, pemetrexed, Rituximab, 100 mg Oncology Related J- References HCPCS Level II Expert 2008. Current Procedural Terminology (CPT) 2008. The Association of Community Cancer Centers Compendia-Based Drug Bulletin August 2007. DrugPoints by Thomson Micromedex 2008 liver and intrahepatic bile ducts (155._) colon (205.0_) prostate (185) colon Lymphoid leukemia-acute colon trachea, bronchus, and lung (162._) pleura (163._) reticulosarcoma (200. ) Rheumatoid arthritis and other inflammatory polyarthropathies (714._) colon unspecified urinary organs Kidney, except pelvis (189.0) unspecified urinary organs Renal pelvis (189.1) ovary Ovary (183.0) stomach (151._) cervix uteri (180._) trachea, bronchus, and lung (162._) ovary (183._) Lymphoid leukemia Acute Price**/ $121.50 $153.41 1/27/2004 $441.95 10/1/2007 N/A $6,250.00 stomach (151._) $11.70 1/1/2008 N/A $3,125.00 trachea, bronchus, and lung (162._) female breast (174._) male breast (175._) Lymphoid leukemia-chronic (204.1_) Immune thrombocytopenic purpura (287.31) Disorders of plasma protein metabolism- $100.00 12/1/2007 $57.43 $623.88 $56.49 96413 $126.31 96413 $290.42 96413 $1,478.28 11981 $9.47 96413 $2,098.87 96401 96413 $82.87 96413 $46.08 96413 $508.66 96413 **The Price is based on the HCPCS. HCPCS (Healthcare Common Procedure Coding System) codes are a component of CMS (Centers for Medicare and Medicaid Services). The Price is an based pricing methodology developed by R J Health Systems International, LLC., Wethersfield, CT American Medical Association. Professional ICD-9-CM 2008 Volumes 1 and 2. AMA Press, 2008. Full prescribing information for each drug listed. The Drug Reimbursement Coding and Pricing Guide by R J Health Systems International, LLC Volume 5, Number 1, 1st Quarter 2008 www.reimbursements.com powered by R J Health Systems International, LLC CMS (Centers for Medicare and Medicaid Services) 1st Quarter s 1/1/08-3/31/08 36 managedcareoncology Spring Quarter 2007 1 2008 managedcareoncology.com 37