This detailed article of codes related to multiple myeloma 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 multiple myeloma.
The following sections include:
- Associated ICD-10-CM codes used for the classification of multiple myeloma
- Drugs that have been approved by the FDA for the treatment of multiple myeloma
- Drugs that are Compendia-listed for off-label use for multiple myeloma 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
C90 | Multiple myeloma and malignant plasma cell neoplasms | ||
C90.0 | Multiple myeloma | ||
C90.00 | Multiple myeloma not having achieved remission | ||
C90.01 | Multiple myeloma in remission | ||
C90.02 | Multiple myeloma in relapse |
Generic (brand) name | HCPCS code—code description | FDA approved for multiple myeloma | Compendia off-label uses for multiple myeloma | Possible CPT® administration codes |
arsenic trioxide (Trisenox) | J9017 - Injection, arsenic trioxide, 1 mg | ✔ | 96413, 96415 | |
bendamustine (Treanda) | J9033 - Injection, bendamustine hydrochloride, 1 mg | ✔ | 96413 | |
betamethasone acetate and sodium phosphate (Celestone Soluspan) | J0702 - Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg | ✔ | 11900, 11901, 20600, 20605, 20610, 96372 | |
bortezomib (Velcade) | J9041 - Injection, bortezomib, 0.1 mg | ✔ | 96409 | |
busulfan (Busulfex) | J0594 - Injection, busulfan, 1 mg | ✔ | 96413, 96415 | |
busulfan (Myleran) | J8510 - Busulfan, oral, 2 mg | ✔ | N/A | |
carfilzomib (Kyprolis) | J9047 - Injection, carfilzomib, 1 mg | ✔ | 96409 | |
carmustine (BiCNU) | J9050 - Injection, carmustine, 100 mg | ✔ | 96413, 96415 | |
cisplatin (Platinol AQ) | J9060 - Injection, cisplatin, powder or solution, per 10 mg | ✔ | 96409, 96413, 96415 | |
cortisone acetate (Cortone) | J8499* - Prescription drug, oral, nonchemotherapeutic, not otherwise specified | ✔ | N/A | |
cyclophosphamide (Cytoxan) | J8530 - Cyclophosphamide, oral, 25 mg | ✔ | N/A | |
cyclophosphamide (Cytoxan) | J9070 - Cyclophosphamide, 100 mg | ✔ | 96409, 96413, 96415 | |
daratumumab (Darzalex) | J9145 - Injection, daratumumab, 10 mg | ✔ | 96413, 96415 | |
dexamethasone (Decadron) | J8540 - Dexamethasone, oral, 0.25 mg | ✔ | N/A | |
dexamethasone (Decadron) | J1100 - Injection, dexamethasone sodium phosphate, 1 mg | ✔ | 11900, 11901, 20600, 20605, 20610, 96372, 96374 | |
doxorubicin HCl (Adriamycin) | J9000 - Injection, doxorubicin hydrochloride, 10 mg | ✔ | 96409 | |
doxorubicin HCl liposomal (Doxil) | Q2050 - Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg | ✔ | 96413 | |
elotuzumab (Empliciti) | J9176 - Injection, elotuzumab, 1 mg | ✔ | 96413, 96415 | |
epirubicin (Ellence) | J9178 - Injection, epirubicin hydrochloride, 2 mg | ✔ | 96409, 96413 | |
epoetin alfa (Epogen, Procrit) | J0885 - Injection, epoetin alfa (for non-ESRD use), 1000 units | ✔ | 96372, 96374 | |
epoetin alfa (Epogen, Procrit) | Q4081 - Injection, epoetin alfa, 100 units (for ESRD on dialysis) | ✔ | 96372, 96374 | |
etoposide (Vepesid) | J8560 - Etoposide, oral, 50 mg | ✔ | N/A | |
etoposide (Etopophos, Toposar) | J9181 - Injection, etoposide, 10 mg | ✔ | 96413, 96415 | |
hydrocortisone (Solu-Cortef) | J1720 - Injection, hydrocortisone sodium succinate, up to 100 mg | ✔ | 96365, 96366, 96372, 96374 | |
hydrocortisone (Cortef) | J8499* - Prescription drug, oral, nonchemotherapeutic, not otherwise specified | ✔ | N/A | |
ifosfamide (Ifex) | J9208 - Injection, ifosfamide, 1 gram | ✔ | 96413, 96415 | |
immune globulin (Bivigam) | J1556 - Injection, immune globulin (Bivigam), 500 mg | ✔ | 96365, 96366 | |
immune globulin (Carimune NF, Gammagard S/D) | J1566 - Injection, immune globulin, intravenous, lyophilized (eg, powder), not otherwise specified, 500 mg | ✔ | 96365, 96366 | |
immune globulin (Flebogamma DIF) | J1572 - Injection, immune globulin (Flebogamma/Flebogamma DIF), intravenous, non-lyophilized (eg, liquid), 500 mg | ✔ | 96365, 96366 | |
immune globulin (Octagam) | J1568 - Injection, immune globulin (Octagam), intravenous, non-lyophilized (eg, liquid), 500 mg | ✔ | 96365, 96366 | |
immune globulin (Privigen) | J1459 - Injection, immune globulin (Privigen), intravenous, non-lyophilized (eg, liquid), 500 mg | ✔ | 96365, 96366 | |
immune globulin (Gammaplex) | J1557 - Injection, immune globulin (Gammaplex), intravenous, non-lyophilized (eg, liquid), 500 mg | ✔ | 96365, 96366, 96369, 96370 | |
immune globulin (Gammagard) | J1569 - Injection, immune globulin (Gammagard liquid), non-lyophilized (eg, liquid), 500 mg | ✔ | 96365, 96366, 96369, 96370 | |
immune globulin (Gammaked, Gamunex-C) | J1561 - Injection, immune globulin (Gamunex-C/Gammaked), non-lyophilized (eg, liquid), 500 mg | ✔ | 96365, 96366, 96369, 96370 | |
interferon alfa-2b (Intron-A) | J9214 - Injection, interferon, alfa-2b, recombinant, 1 million units | ✔ | 96372, 96401 | |
ixazomib (Ninlaro) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
ixazomib (Ninlaro) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
lenalidomide (Revlimid) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
lenalidomide (Revlimid) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
lomustine (CeeNu) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
lomustine (CeeNu) | S0178 - Lomustine, oral, 10 mg | ✔ | N/A | |
melphalan (Alkeran) | J8600 - Melphalan, oral, 2 mg | ✔ | N/A | |
melphalan (Alkeran) | J9245 - Injection, melphalan hydrochloride, 50 mg | ✔ | 96409, 96413 | |
methylprednisolone (Medrol) | J7509 - Methylprednisolone, oral, per 4 mg | ✔ | N/A | |
methylprednisolone (Depo-Medrol) | J1020 - Injection, methylprednisolone acetate, 20 mg | ✔ | 11900, 11901, 20600, 20605, 20610, 96372 | |
methylprednisolone (Depo-Medrol) | J1030 - Injection, methylprednisolone acetate, 40 mg | ✔ | 11900, 11901, 20600, 20605, 20610, 96372 | |
methylprednisolone (Depo-Medrol) | J1040 - Injection, methylprednisolone acetate, 80 mg | ✔ | 11900, 11901, 20600, 20605, 20610, 96372 | |
methylprednisolone (Solu-Medrol) | J2930 - Injection, methylprednisolone sodium succinate, up to 125 mg | ✔ | 96365, 96366, 96372, 96374 | |
paclitaxel (Taxol) | J9267 - Injection, paclitaxel, 1 mg | ✔ | 96413, 96415 | |
panobinostat (Farydak) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
panobinostat (Farydak) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
peginterferon alfa-2b (Peg-Intron) | J3590* - Unclassified biologics | ✔ | 96372 | |
peginterferon alfa-2b (Peg-Intron) | S0148 - Injection, pegylated interferon alfa-2b, 10 mcg | ✔ | 96372 | |
pomalidomide (Pomalyst) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
pomalidomide (Pomalyst) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
prednisolone (eg, Millipred, Prelone) | J7510 - Prednisolone, oral, per 5 mg | ✔ | N/A | |
prednisone (eg, Deltasone, Orasone) | J7506 - Prednisone, oral, per 5 mg | ✔ | N/A | |
procarbazine (Matulane) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
procarbazine (Matulane) | S0182 - Procarbazine hydrochloride, oral, 50 mg | ✔ | N/A | |
teniposide (Vumon) | Q2017 - Injection, teniposide, 50 mg | ✔ | 96413, 96415 | |
thalidomide (Thalomid) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
topotecan (Hycamtin) | J9351 - Injection, topotecan, 0.1 mg | ✔ | 96413 | |
vinCRIStine (Vincasar PFS) | J9370 - Vincristine sulfate, 1 mg | ✔ | 96409 | |
vorinostat (Zolinza) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
*When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (eg, J8999 for Ninlaro) 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 payer regarding correct placement of Medication Information in Item 19 or 24A shaded area. | ||||
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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ESRD indicates end-stage renal disease; HCPCS, Healthcare Common Procedure Coding System. |