₹0. The NDC is updated daily, this version offered here is from September 6th, 2022. 1) • ES-SCLC: when administered with etoposide and either carboplatin or cisplatin, administer IMFINZI 1500 mg every 3 weeks prior todue to Imfinzi’s inability to meet the overall survival primary outcome measures in the phase 3 DANUBE confirmatory trials (Powles 2020). It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. 15 Providers must bill 11-digit NDCs and appropriate NDC units. NDC=National Drug Code. Payers may require the. More about Imfinzi (durvalumab) Check interactions;Explanation of Benefits (EOB) code 06025 - CLAIM REPROCESSED TO PAY USING NADAC (NATIONAL AVERAGE DRUG ACQUISITION COST) PRICING METHODOLOGY. Providers must include the HCPCS procedure code, billing units and corresponding covered NDC number on the claim form. Code 91317 for Pfizer-BioNTech COVID-19. OUT OF STOCK. PH. 4. Call your doctor for medical advice about side effects. See full prescribing information for permanently discontinue for severe or life-threatening pneumonitis. Approval: 2017 . Last updated on emc: 04 Sep 2023. 1007/s11523-021-00843-0. Depending. Food and Drug Administration (FDA) has approved a new dosing regimen for Imfinzi (durvalumab) for the treatment of certain non-small cell lung cancer (NSCLC) and bladder cancer patients. References . On the . 3) • Urothelial Carcinoma: 10 mg/kg every 2 weeks. Please see the HCPCS Quarterly Update webpage for those updates. 58 g/mol. Format revision completed. IMFINZI safely and effectively. A new formulation to incorporate Omicron strain BA. Durvalumab, sold under the brand name Imfinzi, is an FDA-approved immunotherapy for cancer, developed by Medimmune/AstraZeneca. HCPCS codes are reported by the physician, hospital or DME provider that purchased the item, device, or supply. Effective Jan. With IV infusions, the drug is slowly injected. 66019-0309-10. [NDC 58160-976-02] Prefilled syringe (package of 10 syringes per carton) 58160-976-20 0. On October 21, 2022, the Food and Drug Administration approved tremelimumab (Imjudo, AstraZeneca Pharmaceuticals) in combination with durvalumab for adult patients with unresectable hepatocellular. Sean Bohen, MD, Phd. HCPCS/CPT code: J0744 HCPCS/CPT code description: Ciprofloxacin for intravenous infusion, 200 MG Number of HCPCS/CPT units 6 NDC (11-digit billing format): 00409-4765-86 NDC description: Ciprofloxacin IV SOLN 200 MG/20 ML NDC unit of measure ML 8. F. Payers may require the submission of the 11-digit NDC on health care claim forms, and electronic claims may be denied for drugs billed without a valid 11-digit NDC. They may not be reported prior to effective date. Get this at ₹37,310. 24 participants with Non-Small Cell Lung Cancer will be. . Imfinzi is. HCPCS Code Maximum Allowed Brand Generic Actemra tocilizumab 800 mg J3262 800 HCPCs units (1 mg per unit). Updated Nationally Determined Contribution of the Republic of Azerbaijan. (Imfinzi): HCPCS Code J3590 - Unclassified Biologics: Billing Guidelines, 08/17 Eteplirsen injection, for intravenous use (Exondys 51): Change in Coverage, 06/17HCPCS Code (J codes) Update 2017, 01/17 Home Visit for Postnatal Assessment & Follow-Up Care Exceeds 60-Day Limit, 06/17. The EOB 06025 will only appear on the paper RA and will not appear on the X12 835. The EOB 06025 will only appear on the paper RA and will not appear on the X12 835. The NDC code would be unique for all of them and can help you distinguish between those result. MM. Imfinzi targets the PD-1/PD-L1 pathway (proteins found on the body’s immune cells and some cancer cells). IMFINZI is used to treat a type of lung cancer called non- small cell lung cancer (NSCLC) in adults. Imfinzi Injection is used in the treatment of Urinary bladder cancer,Non-small cell lung cancer. The NDC Packaged Code 0310-4500-12 is assigned to a package of 1 vial in 1 carton / 2. renal dysfunction. The safety and tolerability of the Imfinzi combination was consistent with previous. It is a human immunoglobulin G1 kappa (IgG1κ) monoclonal antibody that blocks the interaction of programmed cell death ligand 1 with the PD-1 (CD279). The NDC Packaged Code 0310-4611-50 is assigned to a package of 1 vial in 1 carton / 10 ml in 1 vial of Imfinzi, a human prescription drug labeled by Astrazeneca Pharmaceuticals Lp. Information last updated by Dr. com) document for additional details . Listen to a soundcast of the September 2nd, 2022 FDA approval of Imfinzi (durvalumab) for adult patients with locally advanced or metastatic biliary tract cancer. 5. 099. Rx only. HCPCS (90670 and 90732) to get the Dates of Services for these PPV HCPCS code. Example 1: HCPCS description of drug is 6 mg. Influenza vaccines are licensed each year with new NDCs, so it is important to report the correct code for the products you are using to avoid having claims deny with edit 00996 (Mismatched NDC) which will require the claim to be resubmitted with the correct. HCPCS / NDC Crosswalk for Billing Physician-administered Drugs on the Provider Services Billing Manuals page. HCPCS/CPT Description; G0008: Administration of influenza virus vaccine: 90662: Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use: 90672: Influenza virus vaccine, live, quadrivalent, for intranasal use:Imfinzi (Durvalumab Injection) may treat, side effects, dosage, drug interactions, warnings, patient labeling, reviews, and related medications including drug comparison and health resources. IMFINZI in combination with IMJUDO can cause immune-mediated rash or. applicant, existing HCPCS codes do not identify this product; and given that Rolvedon™ is a single source biological as defined by section 1847A(c)(6)(D) of the Social Security Act, it should be assigned a new HCPCS Level II code and paid separately by Medicare consistent with statute and CMS policy. Imfinzi 120 mg/2. NCCN provides category 2A and 2B recommendations for use of Imfinzi in several types of bladder cancer. 2) 0X/2020Admni siter IMFINZI proi r to chemothearpy on the same day . Report the administration of palivizumab and nirsevimab with code 96372 (injection of a drug or substance, subcutaneous or intramuscular). Imfinzi targets the PD-1/PD-L1 pathway (proteins found on the body’s immune cells and some cancer cells). swelling in your arms and legs. S. S. Code: 00310-4500-12 Description: 1 VIAL in 1 CARTON (0310-4500-12) /. Effective as of July 1, 2023, the following J-code can now be used to identify IMJUDO® (tremelimumab-actl): NDC=National Drug Code. If the NDC on the package label is less than 11 digits, a leading zero must be added to the appropriate segment to create a 5-4-2 configuration. NDC Application Programming Interface (API) (Firefox and Chrome recommended) Finished. 5 mL 10 pre-filled syringes seasonal influenza, quadrivalent, preservative free: 90688 150; 33332-0422-10 multi-dose vial, 5 mL (0. NOTE: Dates of service for Terminated HCPCS codes not needed. 70461-0321-03. Loncastuximab Tesirine is for the treatment of diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL). 1) • Stage III NSCLC: 10 mg/kg every 2 weeks. IMFINZI HCPCS IMJUDO HCPCS Jcode effective dates for dates of service on or after July 1, 2023. Below are examples of drugs and biologicals HCPCS codes, code descriptions and information on units to illustrate and assist in proper billing. No dose reductions are recommended. This revision is due to the Q1 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/2021. 7 months in the placebo group. 1 mL. • HCPCS Level II Procedure and Modifier Codes: Primarily include non-physician products, supplies, and procedures not included in CPT. 10/01/2022 R6 HCPCS J1554 was added to the CPT/HCPCS code section, effective date 4/1/2021. CPT Code Description. (ii) If a labeler code is 4 digits in length, it may be combined only with a product code consisting of 4 digits and a package code consisting of 2 digits for a total NDC length of 10 digits (4. The file contains the following drug information: • NDCPackageCode (Column A): The labeler code, product code, and package code segments of the NDC number, separated by hyphens per FDA website. Example 2: HCPCS description of drug is 50 mg. Durvalumab (IMFINZI ®), a fully human monoclonal antibody against programmed cell death-ligand 1 (PD-L1), is approved for use in combination with etoposide and either carboplatin or cisplatin for the first-line treatment of patients with extensive-stage small cell lung cancer (ES-SCLC). Under CPT/HCPCS Codes added a new Group 2: Paragraph, Group 2: Codes and added C9467 with “Note: For Part A services only - effective on 04/01/2018”. IMFINZI may cause serious or life threatening infusion reactions and infections. For the following HCPCS codes either the short description and/or the long description was changed. This medication may cause a serious reaction during the injection. NDC=National Drug Code. 3. The approval was based on data from the Phase III PACIFIC trial. To report via data exchange, providers would report using the NDC code that is specific to the dose administered. 2 DOSAGE AND ADMINISTRATION 2. 5 mL. (2. About NDC HCPCS Product NDC: 00310-4611 Brand Name: Imfinzi Generic Name: Durvalumab Dosage Form Name: INJECTION, SOLUTION Administration Route:. Vaccine CPT Code to Report. 2021 Nov;16 (6):857-864. 0601C. 3)]. 25 mg/mL bupivacaine and 0. 00 Inclusive of all taxes. SKU Description HCPCS Code NDC-Format Code for Single NDC-Format Code for Carton NDC-Format Code for Case Adult Nutritional 53536 Glucerna 1. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m. The FDA had granted Imfinzi with its bladder cancer indication through the accelerated appr oval program in 2017, with continued approval contingent upon verification of clinical benefit in confirmatory trials. 1%) patient and Grade 3-4 in six (0. For example, the same drug may be produced by many different manufacturers or the same drug may have different dosages. This is not a complete list of. Claims that Contain NDCs Related to Vaccine CPT Codes, 04/17 Clinical Coverage Policies, 02/17, 04/17, 05/17, 06/17, 08/17 CPT Code Update: 2017, 01/17 Discontinuation of Medical/Surgical PA form DMA 372-118, 01/17 The Final 2017 Regional NCTracks Seminar is June 6, 06/17 HCPCS Code (J codes) Update 2017, 01/17This includes restrictions that may be on a deleted code that are continued with the replacement code(s). macugen. Explanation of Benefits (EOB) code 06025 - CLAIM REPROCESSED TO PAY USING NADAC (NATIONAL AVERAGE DRUG ACQUISITION COST) PRICING METHODOLOGY. It provides the criteria used to determine the medical necessity of hospital outpatient administration as the site of service for identified specialty medications (See Site of Care for Specialty Drug Infusion/Injection applicable drug therapy below. • Administer IMFINZI as an intravenous infusion over 60 minutes. NDC Code(s): 0310-4500-12, 0310-4611-50 Packager: AstraZeneca Pharmaceuticals LP; Category: HUMAN PRESCRIPTION DRUG LABEL ; DEA Schedule: None; Marketing Status: Biologic Licensing Application Coding Resource Indications for IMFINZI IMFINZI is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who: havediseaseprogressionduringorfollowingplatinum-containingchemotherapy. 569: $79. Until we get public consultationon national Medicare benefit category determinations and payment determinations for these codes, the Medicare benefit category and coverage/paymentdevice category described by HCPCS code C1832 (Auto cell process). through . This medication can cause rare, but serious. The 835 electronic transactions will include the reprocessed claims along with other claims submitted for the checkwrite. The NDC Packaged Code 0310-4500-12 is assigned to a package of 1 vial in 1 carton / 2. com Abecma (idecabtagene vicleucel) MCP. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination. 94 Section: Prescription Drugs Effective Date: July 1, 2022 Subsection: Antineoplastic Agents Original Policy Date: May 12, 2017 Subject: Imfinzi Page: 1 of 4 Last Review Date: June 16, 2022 Imfinzi Description Imfinzi (durvalumab) Background Imfinzi (durvalumab) is a human immunoglobulin G1 kappa (IgG1κ) monoclonal antibody thatGreater than or equal to 30 kg: 1,500 mg every 3 weeks in combination with tremelimumab-actl 75 mg and platinum-based chemotherapy for 4 cycles, and then administer Imfinzi 1,500 mg every 4 weeks as a single agent with histology-based pemetrexed maintenance therapy every 4 weeks, and a fifth dose of tremelimumab-actl. 01 Learn More About Medical Coding Section 2. Administer IMFINZI as an intravenous. Key points to remember. National Drug Code (NDC) The National Drug Code (NDC) is a universal, unique, 3-segment number identifying drugs by manufacturer, dosage, and package size. (2. 2 DOSAGE AND ADMINISTRATION . Patients receiving the three-drug regimen had a median overall survival of 14 months, as compared with 11. PPENDIX . Imfinzi durvalumab J9173A. NDC covered by VFC Program. 5. Administer IMFINZI prior to chemotherapy when given on the same day. Policy Bulletins are written with medical terminology and in a style common to scientific literature and convention. VI. The Drug Name and NDC Reference Data file: The Drug Name and NDC Reference Data are delivered in one pipe-delimited . Coverage for a Non-FDA approved indication, requires that criteria outlined in Health and Safety Code § 1367. National Comprehensive Cancer Network, Inc. • Should not be assigned to non-drug products. All existing CPT codes that describe COVID-19 vaccine products and associated administration codes that end in “A” for products that are no longer covered under an existing Emergency Use. It is a human immunoglobulin G1 kappa (IgG1κ) monoclonal antibody that blocks the interaction of programmed cell death ligand 1 ( PD-L1 ) with the PD-1 (CD279). PD-L1 acts to switch off immune cells that would otherwise attack the cancer cells. 25 mL • Fluarix 0. Do not freeze or shake. Bahamas. Rx only. Both the product and package codes are assigned by the firm. What you need to know before you are given IMFINZI . On October 21, 2022, the Food and Drug Administration approved tremelimumab (Imjudo, AstraZeneca Pharmaceuticals) in combination with durvalumab for adult patients with. Short descriptor: SARSCOV2 VAC BVL 10MCG/0. IMFINZI™ (durvalumab) Injection. HCPCS code describes JEMPERLI. Billing Code/Availability Information HCPCS:. (2. Identify the specific product and package size. HCPCS codes for Drugs Administered Other Than Oral Method (J Codes) are anticipated to be in NCTracks Jan. Submit PA requests . The Policy Bulletins are used in making decisions as to medical necessity only. The first 5 digits identify the labeler code representing the manufacturer of the drug and are assigned by the Food and Drug Administration (FDA). nervousness. The National Drug Code (NDC) Directory data is offered here in SAS, Stata, and CSV formats to make the whole database a bit easier to use. The first five digits. 21. Imfinzi [package insert]. 17: $76. Strength/Package Size (s): Famotidine injection, 20 mg piggyback, 20 mg/2 mL single. In PET Scan radiopharmaceuticals and Group 1 Codes added: A9591 Fluoroestradiol f 18, diagnostic, 1 millicurie (Cerianna™). Choose Generic substitutes to Save up to 50% off. Imfinzi (durvalumab) is infused into the veins, usually every 2-4 weeks, depending on the cancer. 1, 2019 . 5 mL single-dose prefilled syringe [NDC 58160-976-02] Both UoS NDC numbers will map to the same CVX codes. 4/BA. 5 Blepharospasm and G24. 2. 4 mL single-dose vial: 4 vials per 14 days • Imfinzi 500 mg /10 mL single-dose vial: 2 vials per 14 days B. NDC=National Drug Code. 10-digit, 3-segment number. 3) • Urothelial Carcinoma: 10 mg/kg every 2 weeks. . • Submit the NDC code in the red-shaded portion of the detail line item starting in positions 01 • Precede the NDC with the qualifier N4 and follow it immediately by the 11-digit NDC code (e. (2. 094 Section: Prescription Drugs Effective Date: April 1, 2023 Subsection: Antineoplastic Agents Original Policy Date: May 12, 2017 Subject: Imfinzi Page: 1 of 5 Last Review Date: March 10, 2023 Imfinzi Description Imfinzi (durvalumab) Background Imfinzi (durvalumab) is a human immunoglobulin G1 kappa (IgG1κ) monoclonal antibody thatAt 18 months, 34% of Imfinzi-treated patients were alive, as were 25% of those in the control group. It is for use in adults with: non-small cell lung cancer (NSCLC) that is locally advanced (meaning it has spread into tissues around the lungs, but not to other parts of the body) and cannot be removed by surgery and is not getting worse after radiation treatment and platinum-based chemotherapy (medicines to treat cancer). indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC). skin rash *. In addition to the new alternateBe attentive to the long description of the HCPCS code. The radiopharmaceutical can be administered up to 96 hours before the primary procedure. S. 4 mL single-dose vial: 4 vials per 14 days • Imfinzi 500 mg /10 mL single-dose vial: 2 vials per 14 days B. CMS Local Coverage Determinations (LCDs) and Articles LCD Article Contractor Medicare Part A Medicare Part B L34648 Bisphosphonate Drug Therapy A56907 Billing and Coding: Bisphosphonate Drug Therapy WPS . PPO . Average progression-free survival for the Imfinzi-containing group was 7. 4 mL:The active substance in Imfinzi, durvalumab, is a monoclonal antibody, a type of protein designed to attach to a protein called PD-L1, which is present on the surface of many cancer cells. 5. 5 Cal Ready-to-Hang Institutional / 1 Liter (1000-mL) Bottle / Case of 8 B4154 70074-0535-37 Adult Nutritional 62059 Glucerna Hunger Smart Shake Vanilla Retail / 11. PD-L1 can be induced by inflammatory signals (e. While always displayed as 6 digits in this file; for labeler codes 2 through. You can search with this number to find the exact drug you have. Fig. Drugs are identified and reported using a unique, three-segment number called the National Drug Code (NDC) which serves as the FDA’s identifier for drugs. e When tetanus or rabies products are given as part of wound management, use a primary ICD-10 code which describes the patient’s condition. Do not freeze or shake. (2. Imfinzi (durvalumab) is a programmed death-ligand 1 (PD-L1) blocking antibody indicated for the treatment of patients with. NDC Code(s): 0310-4500-12, 0310-4611-50 Packager: AstraZeneca Pharmaceuticals LP; Category: HUMAN PRESCRIPTION DRUG LABEL ; DEA Schedule: None; Marketing Status: Biologic. Are the HCPCS/CPT/revenue code units different from the NDC units? Yes, use the HCPCS/CPT/revenue code and service units as you have in the past. 90672. With IV infusions, the drug is slowly injected. Pre-Stata13 had a string length limit of 244 characters. Manufacturer: Octapharma USA, Inc. The product's dosage form is injection, solution and is administered via intravenous. As of December 2020, six anti-PD-1/PD-L1 mAbs have been approved with supplemental indications across 19 cancer types and two tissue-agnostic. Imfinzi [prescribing information]. References 1. , N412345678901) When entering supplemental information for NDC, add in the following order: – N4 qualifier – 11-digit NDC code – 1 spaceQ: Why is anNDC needed when drugs are already being billed with HCPCS codes? A: Billing NDCs for shared HCPCS drug codes and NOC drug codes provides the ability to determine precisely which drugs are administered. The 835 electronic transactions will include the reprocessed claims along with other claims. durvalumab injection, for intravenous use (Imfinzi®) 10 mg. ES-SCLC: Until disease progression, unacceptabletoxicity. 57 rescinds legacy NHRIC and NDC numbers and requires discontinuation of their use on device labels and packages, the UDI Rule does not prohibit use of 11-digit numbers or other. CPT codes covered if selection criteria are met: VENTANA PD-L1 (SP263) Assay - no specific code: Other CPT codes related to the CPB: 96413 - 96417 : Chemotherapy. Dosing for infants and children age 6 through 35 months: • Afluria 0. Expression of programmed cell death ligand-1 (PD-L1) protein is an adaptive immune response that helps tumours evade detection and elimination by the immune system. Second claim should be billed from 5/3 through 5/31 with the HCPCS on the 5/3 - 5/31 claim. Approval: 2017 . Page 4 | IMFINZI® (durvalumab) Prior Auth Criteria Proprietary Information. 1)] and 266 patients with ES-SCLC in CASPIAN who received up to four. Imfinzi durvalumab J9173. Restricted Access – Do not disseminate or copyThe Patient Information Leaflet (PIL) is the leaflet included in the pack with a medicine. Trade Name: IMFINZI. ”. of these codes does not guarantee reimbursement. Imfinzi, in combination with gemcitabine and cisplatin, is indicated for the treatment of adult patients with locally advanced or metastatic biliary tract cancer (BTC). , 0001-0001) or the 10 digit NDC (0001-0001-01)) Return to the FDA Label Search Page1. Under the approval, durvalumab can be used as an initial treatment for people with extensive-stage SCLC. Date Article; Nov 11, 2022: Approval Imfinzi and Imjudo with Chemotherapy Approved in the US for Patients with Metastatic Non-Small Cell Lung Cancer: Oct 24, 2022: Approval FDA Approves Imjudo (tremelimumab) in Combination with Imfinzi for Patients with Unresectable Hepatocellular Carcinoma: Sep 11, 2022: Imfinzi and Tremelimumab. Rx only. Imfinzi (durvalumab) may be used as a single agent for consolidation therapy (for a total of 1Imfinzi FDA Approval History. The product-specific HCPCS code for REMICADE® is J1745, infliximab, 10 mg. Coding Resource Indications for IMFINZI IMFINZI is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who:. (iii) The type(s) of drug(s) (human, animal, or both, and prescription, nonprescription, or both) to which the NDC labeler code will be applied. It will be listed in one of the following configurations: 4-4-2: for example,. Units. 11: HCPCS Codes HCPCS codes are a vital part of the coding process. How do I calculate the NDC units? Billing the correct number of NDC units for the. Proper Name: Antihemophilic Factor (Recombinant) Tradename: NUWIQ. Proper billing of a National Drug Code (NDC) requires an 11-digit number in a 5-4-2 format. • Administer IMFINZI as an intravenous infusion over 60 minutes. S. • 10/1/17: billing codes updated • 5/1/18: diagnosis codes updated • 1/3/19: updated billing/coding • 3/28/19: no policy changesDurvalumab (Imfinzi) has been granted a breakthrough therapy designation by the FDA to treat patients with locally-advanced, unresectable non-small cell lung cancer (NSCLC) whose disease has not progressed following platinum-based chemoradiation. MRP ₹45500. It is injected slowly into a vein over 60 minutes as directed by your doctor, usually once every 2 to 4 weeks. This list includes drugs reviewed by NIOSH from January 2012 to December 2013. The National Library of Medicine (NLM)’s DailyMed searchable database provides the most recent labeling submitted to the Food and Drug Administration (FDA) by companies and currently in use (i. IMFINZI ® (durvalumab) injection, for intravenous use Initial U. NDC: 58160-0815-52 (1 dose T-L syringes. The FDA assigns the labeler code, while the company assigns the product and package code. See . Weight less than 30 kg: Imfinzi 20 mg/kg IV given in combination with Imjudo 4 mg/kg as a single dose at Cycle 1/Day 1, followed by Imfinzi as a single agent every 4 weeks . Please Note: For Durable Medical Equipment (DME) MACs only, CPT/HCPCS codes remain located in LCDs. The list of results will include documents which contain the code you entered. 5 mL dosage, for. 7 months in the control arm, according to an FDA announcement regarding the approval. Other changes to the CPT code set. 05 ICD-10-CM. Wilmington, DE: AstraZeneca Pharmaceuticals LP; July 2021. LCDC Building. Sean Bohen, MD, Phd. JEMPERLI is supplied in two single-dose vial (10 mL-200/6 or 20 mL-400/12) sizes. HCPCS Code: J9173 – Injection, durvalumab, 10 mg; 1 billable unit = 10 mg NDC: Imfinzi 120 mg/2. STN: BL 125555. ATC code: L01FF03. October 2023 Alpha-Numeric HCPCS Files (ZIP) - Updated 08/28/2023. This HCPCS Code Application Summary document includes a summary of each HCPCS code application discussed at the May 14, 2018 HCPCS Public Meeting for Drugs, Drugs, Biologicals and Radiopharmaceuticals and Radiologic Imaging Agents. Attention Pharmacist: Dispense the accompanying Medication. H. Each of the drugs in this combination is approved by the Food and Drug Administration (FDA) to treat cancer or conditions related to cancer. Claims that Contain NDCs Related to Vaccine CPT Codes, 04/17 Clinical Coverage Policies, 02/17, 04/17, 05/17, 06/17, 08/17 CPT Code Update: 2017, 01/17 Discontinuation of Medical/Surgical PA form DMA 372-118, 01/17 The Final 2017 Regional NCTracks Seminar is June 6, 06/17 HCPCS Code (J codes) Update 2017, 01/175. The EOB 06025 will only appear on the paper RA and will not appear on the X12 835. 4 mL in 1 VIAL Effective Date: May 1, 2017 Explanation of Benefits (EOB) code 06025 - CLAIM REPROCESSED TO PAY USING NADAC (NATIONAL AVERAGE DRUG ACQUISITION COST) PRICING METHODOLOGY. The recommended dosages for IMFINZI as a single agent and IMFINZI in combination Under CPT/HCPCS Codes Group 27: Codes deleted HCPCS code C0938 and added J9204. 2. Note: Third party payers may have specific policies and guidelines that might require providing additional information on their claim forms. Brand name . Approved Labeled Indication: IMFINZI is indicated for use, in combination with etoposide and either carboplatin or cisplatin, for the first-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC). over 60 minutes every 2 weeks until disease progression or unacceptable toxicity. IMFINZI 20 mg/kg in combination with chemotherapy every 3 weeks (21 days) for 4 cycles, followed by 20 mg/kg every 4 weeks as monotherapy until weight increases to greater than 30 kg. Contents of the pack and other information . 90674. The EOB 06025 will only appear on the paper RA and will not appear on the X12 835. Immune-Mediated Dermatology Reactions. 2 . Each single-dose glass vial is filled with a solution of 29. J9035 is defined in the HCPCS manual as: Injection, bevacizumab, 10 mg. Discard unused portion. 21. This is not a complete list of side effects and others may occur. On October 21, 2022, the Food and Drug Administration approved tremelimumab (Imjudo, AstraZeneca Pharmaceuticals) in combination with durvalumab for adult patients with unresectable hepatocellular. Epub 2021 Nov 3. Max Units (per dose and over time) [HCPCS Unit]: • NSCLC: 112 billable units (1,120 mg) every 14. # Step therapy required through a Humana preferred drug as part of preauthorization. The remaining digits. • Enter the 11-digit NDC, without dashes or spaces, in the drug claim lines – An invalid, incorrect or missing NDC will pay at $0. 4 Adverse Reaction Severity1 Dosage Modification than 5 and up to 10 times ULN or AST or ALT is more than 3 and up to 5 times ULN at baseline and increases to more. Imfinzi Generic Name durvalumab. January 2024 Alpha-Numeric HCPCS Files (ZIP) - Updated 11/21/2023. 25 mL single-dose vial: 25 units: 0310-4505-25: 300. National Drug Code (NDC) 00310-4500 Drug Uses Add to Drug. 34 mg/mL), or 8 mg (2. J0885. Subject: Imfinzi Page: 4 of 4 1. 66019-0308-10. Restricted Access – Do not disseminate or copyImfinzi (durvalumab) is a human monoclonal antibody that binds to PD-L1 and blocks the interaction of PD-L1 with PD-1 and CD80, countering the tumour's immune-evading tactics and releasing the. 82 due to reconsideration requests. Alpha-Numeric HCPCS. HMO Explanation of Benefits (EOB) code 06025 - CLAIM REPROCESSED TO PAY USING NADAC (NATIONAL AVERAGE DRUG ACQUISITION COST) PRICING METHODOLOGY. The NDC is limited to 10 digits, a firm with a 5 digit labeler code must choose between a 3 digit product code and 2 digit package code, or a 4 digit product code and 1 digit package code. 692: 6/30/2023: Merck: 75D30122D14072: Hepatitis A Adult Havrix® 58160-0826-52: 10 pack – 1 dose syringe: $38. 3) • Urothelial Carcinoma: 10 mg/kg every 2 weeks. Indication: Indicated in adults and children with Hemophilia A for: On-demand. Durvalumab Injection, For Intravenous Use (Imfinzi): HCPCS Code J3590 - Unclassified Biologics: Billing Guidelines, 08/17 Eteplirsen injection, for intravenous use (Exondys 51): Change in Coverage, 06/17 Immune globulin subcutaneous (Human), 20 Percent solution (CuvitruTM) HCPCS code J3590: Billing. First claim should be billed from 5/1 through 5/2. It is important to note that this code represents 1/10th of a vial. havediseaseprogressionwithin12monthsofneoadjuvantoradjuvanttreatmentwithplatinum-containingchemotherapy. 5 mLCPT/HCPCS code update effective 01/01/2021: In CPT/HCPCS Group One Codes and Miscellaneous Radiopharmaceuticals Deleted: 78135. change_type,covered_recipient_type,teaching_hospital_ccn,teaching_hospital_id,teaching_hospital_name,covered_recipient_profile_id,covered_recipient_npi,covered. Yes. 5 mL dose) seasonal influenza,HCPCS code Q5124 has been added to the CPT/HCPCS code section. Tell your doctor. View Imfinzi Injection (vial of 10. Imfinzi (Durvalumab Injection) may treat, side effects, dosage, drug interactions, warnings, patient labeling, reviews, and related medications including drug. 5. 1 Melanoma KEYTRUDA® (pembrolizumab) is indicated for the treatment of patients with unresectable or metastatic melanoma. Qualifying notice amendment for Imfinzi. 68 mg/mL), 4 mg (1. HCPCS code applications are presented within the summary document in the same sequence as the Agenda for this Public CPT Codes / HCPCS Codes / ICD-10 Codes ; Code Code Description; Other CPT codes related to the CPB : 81235: EGFR (epidermal growth factor receptor) (eg, non-small cell lung cancer) gene analysis, common variants (eg, exon 19 LREA deletion, L858R, T790M, G719A, G719S, L861Q) 96413 - 96415: Chemotherapy administration, intravenous infusion technique The recommended dose of durvalumab is 10 mg/kg, administered as an intravenous infusion. 90658 can be used for the administration of a flu shot.