Medications Used for the Treatment of Melanoma (Skin Cancer) and the Associated Codes

Kristin A. Esposito, CPhT

Medications Used for the Treatment of Melanoma (Skin Cancer) and the Associated Codes

Clinical Services Manager, RJ Health Systems

This detailed article of codes related to melanoma (skin cancer) is intended to assist practice managers and other healthcare providers and payers to ensure their proper use of coding and billing information associated with the treatment of patients with melanoma.

The following sections include:

Associated ICD-10-CM codes used for the classification of melanoma
Drugs that have been approved by the FDA for the treatment of melanoma
Drugs that are Compendia-listed for off-label use for melanoma based on clinical studies that suggest beneficial use in some cases. Please note: If a check mark appears in the FDA column, it will NOT appear in the Compendia off-label use column
Corresponding HCPCS/CPT^® codes and code descriptions
Possible CPT^® administration codes for the drugs

Associated ICD-10-CM Codes:

C43	Malignant melanoma of skin
	C43.0	Malignant melanoma of lip
	C43.1	Malignant melanoma of eyelid, including canthus
	C43.10	Malignant melanoma of unspecified eyelid, including canthus
	C43.11	Malignant melanoma of right eyelid, including canthus
	C43.12	Malignant melanoma of left eyelid, including canthus
	C43.2	Malignant melanoma of ear and external auricular canal
	C43.20	Malignant melanoma of unspecified ear and external auricular canal
	C43.21	Malignant melanoma of right ear and external auricular canal
	C43.22	Malignant melanoma of left ear and external auricular canal
	C43.3	Malignant melanoma of other and unspecified parts of face
	C43.30	Malignant melanoma of unspecified part of face
	C43.31	Malignant melanoma of nose
	C43.39	Malignant melanoma of other parts of face
	C43.4	Malignant melanoma of scalp and neck
	C43.5	Malignant melanoma of trunk
	C43.51	Malignant melanoma of anal skin
	C43.52	Malignant melanoma of skin of breast
	C43.59	Malignant melanoma of other part of trunk
	C43.6	Malignant melanoma of upper limb, including shoulder
	C43.60	Malignant melanoma of unspecified upper limb, including shoulder
	C43.61	Malignant melanoma of right upper limb, including shoulder
	C43.62	Malignant melanoma of left upper limb, including shoulder
	C43.7	Malignant melanoma of lower limb, including hip
	C43.70	Malignant melanoma of unspecified lower limb, including hip
	C43.71	Malignant melanoma of right lower limb, including hip
	C43.72	Malignant melanoma of left lower limb, including hip
	C43.8	Malignant melanoma of overlapping sites of skin
	C43.9	Malignant melanoma of skin, unspecified

Generic (brand) name

HCPCS code—code description

FDA approved for melanoma (skin cancer)

Compendia off-label uses for melanoma (skin cancer)

Possible CPT^® administration codes

aldesleukin (Proleukin)	J9015 - Injection, aldesleukin, per single-use vial	✔		96409
amifostine (Ethyol)	J0207 - Injection, amifostine, 500 mg		✔	96374
Bacillus Calmette-Guerin (BCG Vaccine)	90585 - Bacillus Calmette-Guerin (BCG) vaccine for tuberculosis, live, for percutaneous use		✔	90471, 90472
Bacillus Calmette-Guerin vaccine (Tice BCG, TheraCys)	90586 - Bacillus Calmette-Guerin (BCG) vaccine for bladder cancer, live, for intravesical use		✔	51720
Bacillus Calmette-Guerin vaccine (Tice BCG, TheraCys)	J9031 - BCG (intravesical), per installation		✔	51720
bleomycin (Blenoxane)	J9040 - Injection, bleomycin sulfate, 15 units		✔	96401, 96409
carboplatin (Paraplatin)	J9045 - Injection, carboplatin, 50 mg		✔	96409, 96413, 96415
carmustine (BiCNU)	J9050 - Injection, carmustine, 100 mg		✔	96413, 96415
cisplatin (Platinol AQ)	J9060 - Injection, cisplatin, powder or solution, per 10 mg		✔	96409, 96413, 96415
cobimetinib (Cotellic)	C9399* - Unclassified drugs or biologicals (Hospital outpatient use only)	✔		N/A
cobimetinib (Cotellic)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified	✔		N/A
dabrafenib (Tafinlar)	C9399* - Unclassified drugs or biologicals (Hospital outpatient use only)	✔		N/A
dabrafenib (Tafinlar)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified	✔		N/A
dacarbazine (DTIC-Dome)	J9130 - Dacarbazine, 100 mg	✔		96409, 96413
dactinomycin (Cosmegen)	J9120 - Injection, dactinomycin, 0.5 mg		✔	96409
docetaxel (Taxotere)	J9171 - Injection, docetaxel, 1 mg		✔	96413
interferon alfa-2b (Intron-A)	J9214 - Injection, interferon, alfa-2b, recombinant, 1 million units	✔		96372, 96401
ipilimumab (Yervoy)	J9228 - Injection, ipilimumab, 1 mg	✔		96413, 96415
lomustine (CeeNU, Gleostine)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified		✔	N/A
lomustine (CeeNU, Gleostine)	S0178 - Lomustine, oral, 10 mg		✔	N/A
megestrol acetate (Megace)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified		✔	N/A
megestrol acetate (Megace)	S0179 - Megestrol acetate, oral 20 mg		✔	N/A
melphalan (Alkeran)	J9245 - Injection, melphalan hydrochloride, 50 mg		✔	96409, 96413
nivolumab (Opdivo)	J9299 - Injection, nivolumab, 1 mg	✔		96413, 96415
paclitaxel (Taxol)	J9265 - Injection, paclitaxel, 30 mg		✔	96413, 96415
peginterferon alfa-2b (Sylatron)	C9399* - Unclassified drugs or biologicals (Hospital outpatient use only)	✔		96372, 96401
peginterferon alfa-2b (Sylatron)	J9999* - Not otherwise classified, antineoplastic drugs	✔		96372, 96401
pembrolizumab (Keytruda)	J9271 - Injection, pembrolizumab, 1 mg	✔		96413
sargramostim (Leukine)	J2820 - Injection, sargramostim (GM-CSF), 50 mcg		✔	96365, 96366, 96372
temozolomide (Temodar)	J8700 - Temozolomide, oral, 5 mg		✔	N/A
trametinib (Mekinist)	C9399* - Unclassified drugs or biologicals (Hospital outpatient use only)	✔		N/A
trametinib (Mekinist)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified	✔		N/A
vemurafenib (Zelboraf)	C9399* - Unclassified drugs or biologicals (Hospital outpatient use only)	✔		N/A
vemurafenib (Zelboraf)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified	✔		N/A
vinBLAStine (Velban)	J9360 - Injection, vinblastine sulfate, 1 mg		✔	96409
vinCRIStine (Vincasar PFS)	J9370 - Vincristine sulfate, 1 mg		✔	96409
When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (eg, J8999 Zelboraf) in Item 24D and the drug name, strength, and NDC (National Drug Code) in Item 19 or 24A (shaded area) to ensure appropriate reimbursement. Please note:* Check with your payer regarding the correct placement of medication information.
References • HCPCS Level II Expert 2016 • Current Procedural Terminology (CPT^®) 2016 • CPT Copyright © 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association • ICD-10-CM for Professionals Volumes 1 & 2 2016 • FDA-approved indication (product Prescribing Information) • Compendia references available upon request • www.ReimbursementCodes.com powered by RJ Health Systems International, LLC, Rocky Hill, CT • CMS (Centers for Medicare & Medicaid Services)
GM-CSF indicates granulocyte-macrophage colony-stimulating factor; HCPCS, Healthcare Common Procedure Coding System.

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www.RJHealthSystems.com

Medications Used for the Treatment of Melanoma (Skin Cancer) and the Associated Codes

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