Payers may require the. This is not a complete list of side effects and others may occur. 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. Patients receiving the three-drug regimen had a median overall survival of 14 months, as compared with 11. NOTE: Dates of service for Terminated HCPCS codes not needed. Format of NDC: Under the proposed rule, the NDC would remain a three-segment numerical code consisting of the labeler code, the product code, and the package code. J0185. 1 Recommended Dosage. These files contain the Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage and pricing data. IMFINZI® (durvalumab) COPYRIGHT 2017 - 2022 ASTRAZENECA CANADA INC. The radiopharmaceutical can be administered up to 96 hours before the primary procedure. Please Note: For Durable Medical Equipment (DME) MACs only, CPT/HCPCS codes remain located in LCDs. HMO . 4 OVERDOSE 10 DESCRIPTION 12 12. 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. (NOC) codes require a corresponding National Drug Code (NDC) to be billed on all claims. On the . 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. 90674. CPT Code Description. Approval: 2017 total bilirubin elevation. Units. There are 11 disease interactions with Imfinzi (durvalumab) which include: adrenal insufficiency. 24 participants with Non-Small Cell Lung Cancer will be. Associated Documents. Although AstraZeneca did not provide specific data in its press release, the company said that patients who were. This code is effective on 11/1/2018. October 2023 Alpha-Numeric HCPCS Files (ZIP) - Updated 08/28/2023. Page 4 | IMFINZI® (durvalumab) Prior Auth Criteria Proprietary Information. Each 3 mL pre-filled single-patient use pen contains semaglutide 2 mg (0. 31, 2018. The list of results will include documents which contain the code you entered. Vaccine CPT Code to Report. 1) 03/2020 Dosage and Administration, Dosage Modifications (2. The most common side effects that occurred in 20% or more of patients receiving Imfinzi were: fatigue, nausea, constipation, decreased appetite, abdominal pain, rash and fever. 10, 2021: NDC requirements have been postponed until 2022. T-MSIS data elements NDC-UNIT-OF-MEASURE (CIP285, CLT229, or COT224) and NDC-QUANTITY (CIP278, CLT230, or COT225) are only applicable to and therefore reported in the IP, LT, and OT files when a value is reported to the NATIONAL-DRUG-CODE data element (CIP284, CLT228, or COT217). Durvalumab (Imfinzi) has been granted a. Subject: Imfinzi Page: 4 of 4 1. A10. FDA Approved: Yes (First approved May 1, 2017) Brand name: Imfinzi Generic name: durvalumab Dosage form: Injection Company: AstraZeneca Treatment for: Non-Small Cell Lung Cancer, Small Cell Lung Cancer, Biliary Tract Tumor,. The recommended dosages for IMFINZI as a single agent and IMFINZI in combination with chemotherapy ar e presented in Table 1 [see . 58%), as well those showing a durable response at one year (23% vs. 5. NDC covered by VFC Program. Rx only. Current through: 11/17/2023. This medication may cause a serious reaction during the injection. 90674. What IMFINZI is and what it is used for . FDA approvals of PD-1/PD-L1 mAbs. 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 (4-4-2). 2021 Nov;16 (6):857-864. 4 mL (50 mg/mL) For Intravenous Infusion After Dilution Single-dose vial. 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. HCPCS code G2012: Brief communication technology-based service, e. The EOB 06025 will only appear on the paper RA and will not appear on the X12 835. Use the units' field as a multiplier to arrive at the dosage amount. 708: 6/30/2023:. • Administer IMFINZI as an intravenous infusion over 60 minutes. 68 mg/mL), 4 mg (1. com) document for additional details . (2. 6 mg are administered = 1 unit is billed. This study has 2 parts: dose finding and dose confirmatory. Proper Name: Antihemophilic Factor (Recombinant) Tradename: NUWIQ. 10/01/2022 R6 HCPCS J1554 was added to the CPT/HCPCS code section, effective date 4/1/2021. Administer IMFINZI as an intravenous infusion after dilutionas recommended [seeDosage and Administration (2. The units submitted for HCPCS, CPT, and Revenue codes are based on the HCPCS,. dose at Cycle 1/Day 1, followed by Imfinzi as a single agent every 4 weeks . 34 mg/mL), or 8 mg (2. Dosing Limits Quantity Limit (max daily dose) [NDC Unit]: Imfinzi 120 mg/2. csv file. Code Description. (2. 1 8. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added J12. Submit PA requests . Serious side effects reported with use of Imfinzi include: rash*. The FDA has approved updated labeling for Imfinzi (durvalumab; AstraZeneca) to include overall survival data for patients with unresectable, Stage III non-small cell lung cancer (NSCLC). 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). July 2023 Alpha-Numeric HCPCS File (ZIP) -. The list of results will include documents which contain the code you entered. Medication HCPCS/CPT Code Injection durvalumab, 10 mg J9173 VII. Imfinzi (durvalumab) may be used as a single agent for consolidation therapy (for a total of 1Imfinzi FDA Approval History. Email: MHILPharmacy@molinahealthcare. However, their Bladder Cancer guidelines have not been updated since the manufacturer’s decision in 2/2021 to withdraw this indication from the FDA label due to Imfinzi’s inability to meet the overall survival primary outcome measures in the Durvalumab, sold under the brand name Imfinzi, is an FDA-approved immunotherapy for cancer, developed by Medimmune/AstraZeneca. Code Description Vial size Billing units. Produced by recombinant DNA technology in Chinese Hamster Ovary (CHO) cell suspension culture, durvalumab is a programmed death-ligand 1 (PD-L1) blocking. (2. Cart Total. Indication: Indicated in adults and children with Hemophilia A for: On-demand. 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 product's dosage form is injection, solution and is administered via intravenous form. dose at Cycle 1/Day 1, followed by Imfinzi as a single agent every 4 weeks . Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added D89. When IMFINZI is administered in combination with chemotherapy, r efer to the Prescribing Information for etoposide and carboplatin or cisplatin for dosni g informaoit n. 1, 2019. SKU Description HCPCS Code NDC-Format Code for Single NDC-Format Code for Carton NDC-Format Code for Case Adult Nutritional 53536 Glucerna 1. 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. Group 1 Codes. headache. Imfinzi (durvalumab) is a human monoclonal antibody that binds to the PD-L1 protein and blocks the interaction of PD-L1 with the PD-1 and CD80 proteins, countering the tumor’s immune-evading. Appendix X Revisions Log . The recommended dosefor IMFINZI monotherapyandIMFINZI combination therapy ispresented in Table 1. May 2021. S. How do I calculate the NDC units? Billing the correct number of NDC units for the. How do I calculate the NDC units? Billing the correct number of NDC units for the. Imfinzi 120 mg/2. HCPCS Code Description J3489 . Providers must include the HCPCS procedure code, billing units and corresponding covered NDC number on the claim form. First claim should be billed from 5/1 through 5/2. 50. 5 mLCPT/HCPCS code update effective 01/01/2021: In CPT/HCPCS Group One Codes and Miscellaneous Radiopharmaceuticals Deleted: 78135. skin rash *. 25 mL single-dose vial: 25 units: 0310-4505-25: 300. 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) 96365 - 96368: Intravenous infusion : 96413 - 96417 IMFINZI, in combination with etoposide and either carboplatin or cisplatin, is . Imfinzi [package insert]. With IV infusions, the drug is slowly injected. 4/BA. trouble. Bavencio avelumab 800 mg J9023 80 HCPCS units (10 mg per unit) Imfinzi durvalumab 1,500 mg J9173 150 HCPCS units (10 mg per unit) Keytruda pembrolizumab 400 mg J9271 400 HCPCS units (1 mg per unit). The 835 electronic transactions will include the reprocessed claims along with other claims. (HCPCS) codes and not otherwise classified (NOC) codes require a corresponding National Drug Code (NDC) to be billed on all. paper. Update Feb. 1 vial = 10 units. Please Note: For Durable Medical Equipment (DME) MACs only, CPT/HCPCS codes remain located in LCDs. The correct use of an ICD-10-CM code does not assure coverage of a service. Imfinzi durvalumab J9173. In PET Scan radiopharmaceuticals and Group 1 Codes added: A9591 Fluoroestradiol f 18, diagnostic, 1 millicurie (Cerianna™). (Imfinzi): HCPCS Code J3590 - Unclassified Biologics: Billing Guidelines, 08/17 Eteplirsen injection, for intravenous use (Exondys 51): Change in Coverage, 06/17ATC code: L01FF03. J1745. (2. 1, 2020, the Medicaid and NC Health Choice programs cover famotidine injection (Pepcid®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs. 21. 6. FFS NDC Codes 8-1-2018 Buckeye, CareSource, Paramount NDC Codes United NDC Codes Molina. 1 mL. Imfinzi disease interactions. Billing Code/Availability Information HCPCS: J9173 Injection, durvalumab, 10 mg: 1 billable unit = 10 mg (effective 1/1/19) J9999 – Not otherwise classified,. Abilify MyCite Kit (aripiprazole with biosensor)- (Medical Necessity) Actemra (tocilizumab). EALTH . 5 mL dosage, for. The NDC Packaged Code 0310-4500-12 is assigned to a package of 1 vial in 1 carton / 2. 4 mL single-dose vial: 00310-4500-xx Imfinzi 500 mg/10 mL single-dose vial: 00310-4611-xx . Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 10 mcg/0. IMFINZI HCPCS IMJUDO HCPCS Jcode effective dates for dates of service on or after July 1,. 5. January 2024 Alpha-Numeric HCPCS Files (ZIP) - Updated 11/21/2023. Durvalumab side effects. Max Units (per dose and over time) [HCPCS Unit]: • NSCLC: 112 billable units (1,120 mg) every 14. The most common side effects of IMFINZI are tiredness, muscle or bone pain, constipation, decreased appetite. 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. More common side effects in people taking Imfinzi for non-small cell lung cancer include: cough*. Example 1: HCPCS description of drug is 6 mg. List of Vaccine Names, Best ASIIS Selection and CPT/CVX Codes This list matches the vaccine name or codes in Arizona State Immunization Information System (ASIIS) with the brand name or other common names. 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. See full prescribing information for IMFINZI. Durvalumab is a human immunoglobulin G1 kappa (IgG1κ) monoclonal antibody and a novel immune-checkpoint inhibitor for cancer treatment. Providers must indicate the number of HCPCS units One Medicaid and NC Health Choice unit of coverage is: 0. allergic reaction *. 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 . Store at 2° to 8°C (36° to 46°F). J7605 Arformoterol, Brovana Arformoterol TartrateExplanation of Benefits (EOB) code 06025 - CLAIM REPROCESSED TO PAY USING NADAC (NATIONAL AVERAGE DRUG ACQUISITION COST) PRICING METHODOLOGY. Dosage Modifications for Adverse Reactions . hoarseness, husky, or loss of voice. CMS Final HCPCS Coding DecisionProviders are responsible for providing medical advice and treatment, are independent contractors, and are not employees or agents of Independence. Code 91317 for Pfizer-BioNTech COVID-19. Researchers randomized patients to receive either Imfinzi or a placebo every two weeks for up to 12. Imfinzi (durvalumab) is a programmed death-ligand 1 (PD-L1) blocking antibody indicated for the treatment of patients with. 1) • Stage III NSCLC: 10 mg/kg every 2 weeks. Continuing therapy with Imfinz will be authorized for 12 months. The Policy Bulletins are used in making decisions as to medical necessity only. The 835 electronic transactions will include the reprocessed claims along with other claims submitted for the checkwrite. Imjudo is also a monoclonal antibody, but it fosters. The list of results will include documents which contain the code you entered. The list of results will include documents which contain the code you entered. Each provider is responsible for ensuring all. RECENT MAJOR CHANGES ----- Indications and Usage (1. 3) 03/2020 Dosage and Administration (2. Imfinzi comes as a liquid solution in single-dose vials. JEMPERLI is supplied in two single-dose vial (10 mL-200/6 or 20 mL-400/12) sizes. Group 1 (9 Codes) Group 1 Paragraph. • 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. 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 TMImmune globulin subcutaneous (Human), 20 Percent solution (Cuvitru ) HCPCS code J3590: Billing Guidelines, 02/17 • Arm 1: IMFINZI 1500 mg administered on Day 1+ gemcitabine 1000 mg/m 2 and cisplatin 25 mg/m 2 (each administered on Days 1 and 8) every 3 weeks (21 days) for up to 8 cycles, followed by IMFINZI 1500 mg every 4 weeks as long as clinical benefit is observed or until unacceptable toxicity, or 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 . This medicinal product is subject to additional monitoring. A copy of the invoice must be submitted when billing for V2790 and 65780 on the same. Cancer Oncology Rx required. While always displayed as 6 digits in this file; for labeler codes 2 through. Information last updated by Dr. 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. 1 Recommended Dosage The recommended dosages for IMFINZI as a single agent and IMFINZI in combination withSide Effects of Imfinzi are Nasopharyngitis (inflammation of the throat and nasal passages), Upper respiratory tract infection, Rash, Flu, Dermatitis, Bronchitis (inflammation of the airways), Eczema, Swelling of lymph nodes, Oropharyngeal pain. com. Each single-dose glass vial is filled with a solution of 29. The CPT procedure codes do not include the cost of the supply. Bahamas Updated. 70461-0323-03 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0. For the following HCPCS codes either the short description and/or the long description was changed. Do not report immunization administration codes 90460-90461 or 90471-90472, as these codes are limited to the administration of vaccine and toxoid products. 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. NDC11: 00904629161: National Drug Code (NDC) in the 11 digit (no dashes) form, also referred to as the CMS 11-digit NDC derivative. Imfinzi is a medicine used to treat lung cancer. They are the basis for your reimbursements. Format revision completed. Codes Listed "By Report" There are certain drugs on the Physician Manual Fee Schedule and on the Ordered Ambulatory Fee Schedule that are designated "By Report" ("BR"). HCPCS Code (J codes) Update 2017, 01/17 Home Visit for Postnatal Assessment & Follow-Up Care Exceeds 60-Day Limit, 06/17 ICD-10 Annual Update, 10/17 Incomplete Manage Change Requests and Enrollment Applications, 09/17 Maintain Eligibility Process, 06/17, 07/17, 08/17, 09/17, 10/17This page provides the clinical criteria documents for all injectable, infused, or implanted prescription drugs and therapies covered under the medical benefit. 02 Medical Coding Vocabulary & Key Terms Section 2. In addition to the new alternateBe attentive to the long description of the HCPCS code. FDA publishes the listed NDC numbers and the information submitted as part of the listing information in the NDC Directory which is updated daily. It’s given as an IV infusion. The following HCPCS codes are considered medically necessary when filed with the ICD-10 diagnosis codes listed below. ₹0. Submit the NDC in its 5-4-2 digit format: XXXXX-XXXX-XX. 5. (NOC) codes require a corresponding National Drug Code (NDC) to be billed on all claims. No needle) 90636: 104 MenHibrix (VFC) Meningococcal C/Y-HIB PRP 6 weeks -. Therapy should continue as long as clinical benefit is observed or until unacceptable toxicity. The NDC code can be found on the outside packaging of the drug. Report code only with appropriate primary procedure. Injection, epoetin alfa (for non-ESRD use), 1000 units. FOLFIRINOX is used to treat: Pancreatic cancer that has metastasized (spread to other parts of the body). NDC=National Drug Code. (2. pneumonitis * ( inflammation of the lungs) hair loss. muscle cramps and stiffness. Injectable medications (continued) J0896 Renflexis J2794 Q9991 Synagis J9269National Drug Code Directory. 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. Seventeen5. allergic reaction *. Note that not all products and NDCs under their respective CPT codes will be covered. S. It showed an. Ottawa ON K1A 0K9. (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. On September 2, 2022, the Food and Drug Administration approved durvalumab (Imfinzi, AstraZeneca UK Limited) in combination with gemcitabine and cisplatin for adult patients with locally advanced. 2 Non-Small Cell Lung Cancer KEYTRUDA, in combination with pemetrexed and platinum chemotherapy, is indicated for the first-lineThe recommended dose of IMFINZI is 10 mg/kg administered as an intravenous infusion over 60 minutes every 2 weeks until disease progression, unacceptable toxicity, or a maximum of 12 months. Example claim with HCPCS by itself: HCPCS rate changed 5/19. Rx only. It’s given as an IV infusion. The NDC Code 0310-4500-12 is assigned to “Imfinzi ” (also known as: “Durvalumab”), a human prescription drug labeled by “AstraZeneca Pharmaceuticals LP”. 1) • ES-SCLC: when administered with etoposide and either carboplatin or cisplatin, administer IMFINZI 1500 mg every 3 weeks prior to chemotherapy and then everyHCPCS Code: • J9173 – Injection, durvalumab, 10 mg; 1 billable unit = 10 mg NDC: • Imfinzi 120 mg/2. Injection, zoledronic acid, 1 mg . provider administered drugs page 2 of 3 . 4. Explanation of Benefits (EOB) code 06025 - CLAIM REPROCESSED TO PAY USING NADAC (NATIONAL AVERAGE DRUG ACQUISITION COST) PRICING METHODOLOGY. Immune-mediated nephritis occurred in 1% (4/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (0. Imfinzi targets the PD-1/PD-L1 pathway (proteins found on the body’s immune cells and some cancer cells). Imfinzi (durvalumab) may be considered medically necessary for the treatment of adults with: • Unresectable, stage III non-small cell lung cancer (NSCLC) whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy • First-line treatment of extensive-stage small cell lung cancerThe HIPAA standard 11-digit NDC format is standardized such that the labeler code is always 5 digits, the product code is always 4 digits, and the package code always 2 digits. Item Code (Source) NDC:0310-4500: Route of Administration: INTRAVENOUS: Active Ingredient/Active Moiety: Ingredient Name Basis of Strength Strength; DURVALUMAB (UNII: 28X28X9OKV) (DURVALUMAB - UNII:28X28X9OKV) DURVALUMAB: 120 mg in 2. 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”. Please see Important Safety Information throughout and Full Prescribing Information including Medication Guide for IMFINZI and IMJUDO. IMFINZI™. 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. The EOB 06025 will only appear on the paper RA and will not appear on the X12 835. Moderna Statement: “NDC codes 80777-280-99 and 80777-280-05 were provided in anticipation of FDA authorization under EUA for a bivalent booster vaccine (Moderna COVID-19 Vaccine, Bivalent). National Comprehensive Cancer Network, Inc. IMFINZI in combination with IMJUDO can cause immune-mediated nephritis. Code: 00310-4500-12 Description: 1 VIAL in 1 CARTON (0310-4500-12) /. The Clinical Criteria information is alphabetized in the. 5 mL. Biologic and Radiopharmaceutical Drugs Directorate. (NDC 0310-4611-50) 120 mg/2. . Always bill device in the category described by HCPCS code C1832 with 1 of the following CPT codes: • CPT code 15110 (Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children), which is assigned to APC 5054 for. Imfinzi will be authorized for 6 months when criteria for initial approval are met. The EOB 06025 will only appear on the paper RA and will not appear on the X12 835. 25 mg/mL bupivacaine and 0. FDA’s National Drug Code (NDC) Directory contains information about finished drug products, unfinished drugs and compounded drug products. Full prescribing. 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. [NDC 58160-976-02] Prefilled syringe (package of 10 syringes per carton) 58160-976-20 0. IMFINZI works by helping your immune system fight your cancer. com. Fig. Explanation of Benefits (EOB) code 06025 - CLAIM REPROCESSED TO PAY USING NADAC (NATIONAL AVERAGE DRUG ACQUISITION COST) PRICING METHODOLOGY. 10 mg vial of drug is administered = 10 units are billed. The official update of the HCPCS code system is available as a public use file below. How you are given IMFINZI . 25 mg/mL bupivacaine and 0. Max Units (per dose and over time) [HCPCS Unit]: • NSCLC: 112 billable units (1,120 mg) every 14 days Xolair omalizumab 600 mg J2357 120 HCPCS units (5 mg per unit) Bavencio avelumab 800 mg J9023 80 HCPCS units (10 mg per unit) Imfinzi durvalumab 1,500 mg J9173 150 HCPCS units (10 mg per unit) Keytruda pembrolizumab 400 mg J9271 400 HCPCS units (1 mg per unit) Libtayo cemiplimab-rwlc 350 mg J9119 350 HCPCS units (1 mg per unit) 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 Guidelines, 02/17 Durvalumab: A Review in Extensive-Stage SCLC. HCPCS Code (J codes) Update 2017, 01/17 Home Visit for Postnatal Assessment & Follow-Up Care Exceeds 60-Day Limit, 06/17. It is a human immunoglobulin G1 kappa. Withhold for moderate and permanently discontinue for severe or life-Initial U. 68 mg/mL). Bavencio avelumab 800 mg J9023 80 HCPCS units (10 mg per unit) Imfinzi durvalumab 1,500 mg J9173 150 HCPCS units (10 mg per unit) Keytruda pembrolizumab 400 mg J9271 400 HCPCS units (1 mg per unit). Group 1. 88 mg/mL meloxicam. 70461-0322-03. through . The NDC will be in one of the following configurations: 4-4-2, 5-3-2, or 5-4-1. • Enter the 11-digit NDC, without dashes or spaces, in the drug claim lines – An invalid, incorrect or missing NDC will pay at $0. 1. IMFINZI HCPCS IMJUDO HCPCS Jcode effective dates for dates of service on or after July 1, 2023. The U. 6 5. The file contains the following drug information: • NDCPackageCode (Column A): The labeler code, product code, and package code segments of the National Drug Code number, separated by hyphens per FDA website. indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC). Applicant suggested language: JXXXX macimorelin 60 mg, oral solution. 25 mL • Fluarix 0. National Drug Code (NDC) numbers for use in billing physician-administered drugs, please refer to the . NCCN provides category 2A and 2B recommendations for use of Imfinzi in several types of bladder cancer. It is a type of immunotherapy and belongs to a group of medicines called immune checkpoint. Imjudo (tremelimumab) is given for one cycle followed by single agent Imfinzi (durvalumab). (B) A product code consisting of 3 digits and a package code consisting of 2 digits for a total NDC length of 10 or 11 digits (5–3–2 or 6–3–2). 2) 0X/2020Admni siter IMFINZI proi r to chemothearpy on the same day . S. doi: 10. com Abecma (idecabtagene vicleucel) MCP. 3)]. Accessed on May 11, 2021. The definition of the HCPCS code specifies the lowest common denominator of the amount of dosage. Tell your caregiver right away if you feel light-headed or itchy, or if you have a fever, chills, neck or back pain, trouble breathing,. 1) • ES-SCLC: when administered with etoposide and either carboplatin or cisplatin, administer IMFINZI 1500 mg every 3 weeks prior to• IMFINZI is approved for the treatment of patients with unresectable Stage III non-small cell lung cancer (NSCLC) whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy (CRT)1 • IMFINZI is a human monoclonal antibody directed against programmed cell death ligand-1 (PD-L1)1Imfinzi™ (durvalumab) Last Review Date: January 1, 2019 Number: MG. OLORADO . • Administer IMFINZI as an intravenous infusion over 60 minutes. Last updated on Jun 28, 2023. These codes are also located in the Medicine section of the CPT code set. Keep vial in original carton to protect from light. IMFINZI contains the active ingredient durvalumab. Clinical Studies (14) ]. The FDA has approved Imfinzi (durvalumab) for the treatment of patients with locally advanced, unresectable stage 3 non—small cell lung cancer (NSCLC) who have not progressed following chemoradiotherapy. The EOB 06025 will only appear on the paper RA and will not appear on the X12 835. 58 g/mol. Imfinzi comes as a liquid solution in single-dose vials. This list includes drugs reviewed by NIOSH from January 2012 to December 2013. Brand name . 05 ICD-10-CM. All other Codes (ICD-10, Bill Type, and Revenue) have moved to Articles for DME MACs, as they have for the other Local Coverage MAC types. FDA’s National Drug Code (NDC) Directory contains information about finished drug products, unfinished drugs and compounded drug products. 3) • Urothelial Carcinoma: 10 mg/kg every 2 weeks. Example: rilpivirine STR=ndc_active_ingredient. HCPCS code V2790 (amniotic membrane for surgical reconstruction, per procedure) should not be billed to Part B separately except as noted below: •HCPCS code V2790 can be reimbursed separately in an office setting when billed with CPT Code 65780. Covered services will be processed according to the chart below. code . 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, 01/17Imfinzi belongs to a class of drugs called PD-L1 inhibitors. 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. NDC=National Drug Code. LCDC Building. 21. National. The EOB 06025 will only appear on the paper RA and will not appear on the X12 835. g. csv file. 3) • Urothelial Carcinoma: 10 mg/kg every 2 weeks. dose at Cycle 1/Day 1, followed by Imfinzi as a single agent every 4 weeksImfinzi (durvalumab) is an immunotherapy used in a variety of cancers, including lung cancer and liver cancer. 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. Each of the drugs in this combination is approved by the Food and Drug Administration (FDA) to treat cancer or conditions related to cancer. Imfinzi was previously granted accelerated approval in 2017 for the treatment of certain patients with locally advanced or metastatic. Call your doctor for medical advice about side effects. 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. 4 mL injection. The NDC must follow the 5digit4digit2digit format (11-digit billing format, with no spaces, hyphens or special characters). Note: Third party payers may have specific policies and guidelines that might require providing additional information on their claim forms. It is supplied by AstraZeneca. Explanation of Benefits (EOB) code 06025 - CLAIM REPROCESSED TO PAY USING NADAC (NATIONAL AVERAGE DRUG ACQUISITION COST) PRICING METHODOLOGY. Imfinzi is. This video will teach you the format of these codes and how they interact with CPT codes, ICD codes, and Medicare and Medicaid. over 60 minutes every 2 weeks until disease progression or unacceptable toxicity. As of April 2020, the Alpha-Numeric HCPCS File is a quarterly file. The EOB 06025 will only appear on the paper RA and will not appear on the X12 835. 8. Tell your doctor. While 21 CFR 801. Report 90472 and 90473 in addition to 90460 or 90471 or 90473. The National Drug Code (NDC) Directory is updated daily. 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. National Drug Code (NDC) The National Drug Code (NDC) is a universal, unique, 3-segment number identifying drugs by manufacturer, dosage, and package size. 4 ml in 1 vial of Imfinzi, a human prescription drug labeled by Astrazeneca Pharmaceuticals Lp. The NDC number consists of 11 digits in a 5-4-2 format. 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, 01/17 Imfinzi belongs to a class of drugs called PD-L1 inhibitors. 2 DOSAGE AND ADMINISTRATION 2. Expand All | Collapse All. 1. com. Granted under priority review, the approval allows Imfinzi to be administered at a fixed dose of 1,500 mg every four weeks for patients. Brand name .