This detailed article of codes related to kidney cancers is intended to assist practice managers and other healthcare providers and payers to ensure the proper use of coding and billing information associated with the treatment of patients with kidney cancers.
The following sections include:
- Associated ICD-10-CM codes used for the classification of kidney cancers
- Drugs that have been approved by the FDA for the treatment of kidney cancers
- Drugs that are Compendia-listed for off-label use for kidney cancers 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
| C64 | Malignant neoplasm of kidney, except renal pelvis | ||
| C64.1 | Malignant neoplasm of right kidney, except renal pelvis | ||
| C64.2 | Malignant neoplasm of left kidney, except renal pelvis | ||
| C64.9 | Malignant neoplasm of unspecified kidney, except renal pelvis | ||
| C65 | Malignant neoplasm of renal pelvis | ||
| C65.1 | Malignant neoplasm of right renal pelvis | ||
| C65.2 | Malignant neoplasm of left renal pelvis | ||
| C65.9 | Malignant neoplasm of unspecified renal pelvis | ||
| C68 | Malignant neoplasm of other and unspecified urinary organs | ||
| C68.9 | Malignant neoplasm of urinary organ, unspecified | ||
| Generic (brand) name | HCPCS code—code description | FDA approved for kidney cancers | Compendia off-label uses for kidney cancers | Possible CPT® administration codes |
| aldesleukin (Proleukin) | J9015 - Injection, aldesleukin, per single-use vial | ✔ | 96409 | |
| axitinib (Inlyta) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
| axitinib (Inlyta) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
| bevacizumab (Avastin) | J9035 - Injection, bevacizumab, 10 mg | ✔ | 96413, 96415 | |
| cabozantinib (Cabometyx) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
| cabozantinib (Cabometyx) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
| capecitabine (Xeloda) | J8520 - Capecitabine, oral, 150 mg | ✔ | N/A | |
| capecitabine (Xeloda) | J8521 - Capecitabine, oral, 500 mg | ✔ | N/A | |
| carboplatin (Paraplatin) | J9045 - Injection, carboplatin, 50 mg | ✔ | 96409, 96413, 96415 | |
| cyclophosphamide (Cytoxan) | J8530 - Cyclophosphamide, oral, 25 mg | ✔ | N/A | |
| cyclophosphamide (Cytoxan) | J9070 - Cyclophosphamide, 100 mg | ✔ | 96409, 96413, 96415 | |
| dactinomycin (Cosmegen) | J9120 - Injection, dactinomycin, 0.5 mg | ✔ | 96409 | |
| doxorubicin HCl (Adriamycin) | J9000 - Injection, doxorubicin hydrochloride, 10 mg | ✔ | 96409 | |
| etoposide (Vepesid) | J8560 - Etoposide, oral, 50 mg | ✔ | N/A | |
| etoposide (Etopophus, Toposar) | J9181 - Injection, etoposide, 10 mg | ✔ | 96413, 96415 | |
| everolimus (Afinitor) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
| everolimus (Afinitor) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
| floxuridine (FUDR) | J9200 - Injection, floxuridine, 500 mg | ✔ | 96422, 96423, 96425 | |
| fluorouracil (Adrucil) | J9190 - Injection, fluorouracil, 500 mg | ✔ | 96409 | |
| gemcitabine (Gemzar) | J9201 - Injection, gemcitabine hydrochloride, 200 mg | ✔ | 96413 | |
| ifosfamide (Ifex) | J9208 - Injection, ifosfamide, 1 g | ✔ | 96413, 96415 | |
| interferon alfa-2b (Intron-A) | J9214 - Injection, interferon, alfa-2b, recombinant, 1 million units | ✔ | 96372, 96401 | |
| interferon gamma-1b (Actimmune) | J9216 - Injection, interferon, gamma-1b, 3 million units | ✔ | 96372 | |
| medroxyprogesterone acetate (Depo-Provera 400 mg only) | J1050 - Injection, medroxyprogesterone acetate, 1 mg | ✔ | 96372, 96402 | |
| methotrexate | J9250 - Methotrexate sodium, 5 mg | ✔ | 96372, 96374, 96401, 96409, 96450 | |
| methotrexate | J9260 - Methotrexate sodium, 50 mg | ✔ | 96372, 96374, 96401, 96409, 96450 | |
| nivolumab (Opdivo) | J9299 - Injection, nivolumab, 1 mg | ✔ | 96413, 96415 | |
| pazopanib (Votrient) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
| pazopanib (Votrient) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
| peginterferon alfa-2a (Pegasys) | J3590* - Unclassified biologics | ✔ | 96372 | |
| peginterferon alfa-2a (Pegasys) | S0145 - Injection, pegylated interferon alfa-2a, 180 mcg/mL | ✔ | 96372 | |
| pemetrexed (Alimta) | J9305 - Injection, pemetrexed, 10 mg | ✔ | 96409 | |
| sargramostim (Leukine) | J2820 - Injection, sargramostim (GM-CSF), 50 mcg |
✔ | 96365, 96366, 96372 | |
| sorafenib (Nexavar) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
| sorafenib (Nexavar) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
| sunitinib (Sutent) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
| sunitinib (Sutent) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
| temsirolimus (Torisel) | J9330 - Injection, temsirolimus, 1 mg | ✔ | 96413 | |
| thalidomide (Thalomid) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
| topotecan (Hycamtin) | J9351 - Injection, topotecan, 0.1 mg | ✔ | 96413 | |
| 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 for Afinitor) 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. | ||||
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References • HCPCS Level II Expert 2017 • Current Procedural Terminology (CPT®) 2017 • CPT Copyright © 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association • ICD-10-CM for Professionals Volumes 1 & 2 2017 • 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) |
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| GM-CSF indicates granulocyte-macrophage colony-stimulating factor; HCPCS, Healthcare Common Procedure Coding System. | ||||