Medications Used for the Treatment of Breast Cancer and Their Associated ICD-10 Codes

Kristin A. Esposito, CPhT

October 2016, Vol 6, No 10 - Breast Cancer, ICD Codes


This detailed article of codes related to breast cancer 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 breast cancer.

The following sections include:

  • Associated ICD-10-CM codes used for the classification of breast cancer
  • Drugs that have been approved by the FDA for the treatment of breast cancer
  • Drugs that are Compendia-listed for off-label use for breast cancer 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

    C50 Malignant neoplasm of breast
      C50.0 Malignant neoplasm of nipple and areola
      C50.01 Malignant neoplasm of nipple and areola, female
      C50.011 Malignant neoplasm of nipple and areola, right female breast
      C50.012 Malignant neoplasm of nipple and areola, left female breast
      C50.019 Malignant neoplasm of nipple and areola, unspecified female breast
      C50.02 Malignant neoplasm of nipple and areola, male
      C50.021 Malignant neoplasm of nipple and areola, right male breast
      C50.022 Malignant neoplasm of nipple and areola, left male breast
      C50.029 Malignant neoplasm of nipple and areola, unspecified male breast
      C50.1 Malignant neoplasm of central portion of breast
      C50.11 Malignant neoplasm of central portion of breast, female
      C50.111 Malignant neoplasm of central portion of right female breast
      C50.112 Malignant neoplasm of central portion of left female breast
      C50.119 Malignant neoplasm of central portion of unspecified female breast
      C50.12 Malignant neoplasm of central portion of breast, male
      C50.121 Malignant neoplasm of central portion of right male breast
      C50.122 Malignant neoplasm of central portion of left male breast
      C50.129 Malignant neoplasm of central portion of unspecified male breast
      C50.2 Malignant neoplasm of upper-inner quadrant of breast
      C50.21 Malignant neoplasm of upper-inner quadrant of breast, female
      C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
      C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
      C50.219 Malignant neoplasm of upper-inner quadrant of unspecified female breast
      C50.22 Malignant neoplasm of upper-inner quadrant of breast, male
      C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
      C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
      C50.229 Malignant neoplasm of upper-inner quadrant of unspecified male breast
      C50.3 Malignant neoplasm of lower-inner quadrant of breast
      C50.31 Malignant neoplasm of lower-inner quadrant of breast, female
      C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
      C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
      C50.319 Malignant neoplasm of lower-inner quadrant of unspecified female breast
      C50.32 Malignant neoplasm of lower-inner quadrant of breast, male
      C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
      C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
      C50.329 Malignant neoplasm of lower-inner quadrant of unspecified male breast
      C50.4 Malignant neoplasm of upper-outer quadrant of breast
      C50.41 Malignant neoplasm of upper-outer quadrant of breast, female
      C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
      C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
      C50.419 Malignant neoplasm of upper-outer quadrant of unspecified female breast
      C50.42 Malignant neoplasm of upper-outer quadrant of breast, male
      C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
      C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
      C50.429 Malignant neoplasm of upper-outer quadrant of unspecified male breast
      C50.5 Malignant neoplasm of lower-outer quadrant of breast
      C50.51 Malignant neoplasm of lower-outer quadrant of breast, female
      C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
      C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
      C50.519 Malignant neoplasm of lower-outer quadrant of unspecified female breast
      C50.52 Malignant neoplasm of lower-outer quadrant of breast, male
      C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
      C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
      C50.529 Malignant neoplasm of lower-outer quadrant of unspecified male breast
      C50.6 Malignant neoplasm of axillary tail of breast
      C50.61 Malignant neoplasm of axillary tail of breast, female
      C50.611 Malignant neoplasm of axillary tail of right female breast
      C50.612 Malignant neoplasm of axillary tail of left female breast
      C50.619 Malignant neoplasm of axillary tail of unspecified female breast
      C50.62 Malignant neoplasm of axillary tail of breast, male
      C50.621 Malignant neoplasm of axillary tail of right male breast
      C50.622 Malignant neoplasm of axillary tail of left male breast
      C50.629 Malignant neoplasm of axillary tail of unspecified male breast
      C50.8 Malignant neoplasm of overlapping sites of breast
      C50.81 Malignant neoplasm of overlapping sites of breast, female
      C50.811 Malignant neoplasm of overlapping sites of right female breast
      C50.812 Malignant neoplasm of overlapping sites of left female breast
      C50.819 Malignant neoplasm of overlapping sites of unspecified female breast
      C50.82 Malignant neoplasm of overlapping sites of breast, male
      C50.821 Malignant neoplasm of overlapping sites of right male breast
      C50.822 Malignant neoplasm of overlapping sites of left male breast
      C50.829 Malignant neoplasm of overlapping sites of unspecified male breast
      C50.9 Malignant neoplasm of breast of unspecified site
      C50.91 Malignant neoplasm of breast of unspecified site, female
      C50.911 Malignant neoplasm of breast of unspecified site of right female breast
      C50.912 Malignant neoplasm of breast of unspecified site left female breast
      C50.919 Malignant neoplasm of breast of unspecified site of unspecified female breast
      C50.92 Malignant neoplasm of breast of unspecified site, male
      C50.921 Malignant neoplasm of breast of unspecified site of right male breast
      C50.922 Malignant neoplasm of breast of unspecified site of left male breast
      C50.929 Malignant neoplasm of breast of unspecified site of unspecified male breast
    Generic (brand) name HCPCS code—code description FDA approved for breast cancer Compendia off-label uses for breast cancer Possible CPT® administration codes
    ado-trastuzumab emtansine (Kadcyla) J9354 – Injection, ado-trastuzumab emtansine, 1 mg   96413, 96415
    anastrozole (Arimidex) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
    anastrozole (Arimidex) S0170 – Anastrozole, oral, 1 mg   N/A
    Bacillus Calmette-Guérin (BCG Vaccine) 90585 – Bacillus Calmette-Guérin vaccine (BCG) for tuberculosis, live, for percutaneous use   90471, 90472
    Bacillus Calmette-Guérin (Tice BCG, TheraCys) 90586 – Bacillus Calmette-Guérin vaccine (BCG) for bladder cancer, live, for intravesical use   51720
    Bacillus Calmette-Guérin (Tice BCG, TheraCys) J9031 – bCG (intravesical), per installation   51720
    bendamustine (Treanda) J9033 – Injection, bendamustine hydrochloride, 1 mg   96413
    bevacizumab (Avastin) J9035 – Injection, bevacizumab, 10 mg   96413, 96415
    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
    cisplatin (Platinol AQ) J9060 – Injection, cisplatin, powder or solution, per 10 mg   96409, 96413, 96415
    cyclophosphamide (Cytoxan) J8530 – Cyclophosphamide, oral, 25 mg   N/A
    cyclophosphamide (Cytoxan) J9070 – Cyclophosphamide, 100 mg   96409, 96413, 96415
    dexamethasone (Decadron) J1100 – Injection, dexamethasone sodium phosphate, 1 mg   11900, 11901, 20600, 20605, 20610, 96372, 96374
    dexamethasone (Decadron) J8540 – Dexamethasone, oral, 0.25 mg   N/A
    docetaxel (Taxotere) J9171 – Injection, docetaxel, 1 mg   96413
    doxorubicin HCl (Adriamycin) J9000 – Injection, doxorubicin hydrochloride, 10 mg   96409
    doxorubicin HCl liposome (Doxil) Q2050 – Injection, doxorubicin hydrochloride, liposomal, 10 mg, not otherwise specified   96413
    epirubicin (Ellence) J9178 – Injection, epirubicin hydrochloride, 2 mg   96409, 96413
    eribulin (Halaven) J9179 – Injection, eribulin mesylate, 0.1 mg   96409
    estradiol (Estrace) J8499* – Prescription drug, oral, nonchemotherapeutic, not otherwise specified   N/A
    etoposide (Vepesid) J8560 – Etoposide, oral, 50 mg   N/A
    etoposide (Etopophos, 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
    exemestane (Aromasin) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
    exemestane (Aromasin) S0156 – Exemestane, 25 mg   N/A
    fluorouracil (Adrucil) J9190 – Injection, fluorouracil, 500 mg   96409
    fluoxymesterone (Androxy) J8499* – Prescription drug, oral, nonchemotherapeutic, not otherwise specified   N/A
    fulvestrant (Faslodex) J9395 – Injection, fulvestrant, 25 mg   96402
    gemcitabine (Gemzar) J9201 – Injection, gemcitabine hydrochloride, 200 mg   96413
    goserelin acetate (Zoladex 3.6 mg ONLY) J9202 – Goserelin acetate implant, per 3.6 mg   96372, 96402
    hydrocortisone sodium (Solu-Cortef) J1720 – Injection, hydrocortisone sodium succinate, up to 100 mg   96365, 96366, 96372, 96374
    hydroxyurea (Hydrea) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
    hydroxyurea (Hydrea) S0176 – Hydroxyurea, oral, 500 mg   N/A
    ifosfamide (Ifex) J9208 – Injection, ifosfamide, 1 gram   96413, 96415
    irinotecan (Camptosar) J9206 – Injection, irinotecan, 20 mg   96413, 96415
    ixabepilone (Ixempra) J9207 – Injection, ixabepilone, 1 mg   96413, 96415
    lapatinib (Tykerb) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
    letrozole (Femara) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
    leucovorin calcium (Wellcovorin) J0640 – Injection, leucovorin calcium, per 50 mg   96372, 96374, 96409
    leuprolide (Eligard, Lupron Depot) J9217 – Leuprolide acetate (for depot suspension), 7.5 mg   96402
    leuprolide (Lupron) J9218 – Leuprolide acetate, per 1 mg   96402
    lomustine (CeeNu) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
    lomustine (CeeNU) S0178 – Lomustine, oral, 10 mg   N/A
    medroxyprogesterone (Depo-Provera) J1050 – Injection, medroxyprogesterone acetate, 1 mg   96372, 96402
    megestrol (Megace) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
    megestrol (Megace) S0179 – Megestrol acetate, oral, 20 mg   N/A
    melphalan (Alkeran) J8600 – Melphalan, oral, 2 mg   N/A
    melphalan (Alkeran) J9245 – Injection, melphalan hydrochloride, 50 mg   96409, 96413
    methotrexate (Trexall) J8610 – Methotrexate, oral, 2.5 mg   N/A
    methotrexate sodium J9250 – Methotrexate sodium, 5 mg   96372, 96374, 96401, 96409, 96450
    methotrexate sodium J9260 – Methotrexate sodium, 50 mg   96372, 96374, 96401, 96409, 96450
    methylprednisolone (Depo-Medrol) J1020 – Injection, methylprednisolone acetate, 20 mg   11900, 11901, 20600, 20605, 20610, 96372, 96374
    methylprednisolone (Depo-Medrol) J1030 – Injection, methylprednisolone acetate, 40 mg   11900, 11901, 20600, 20605, 20610, 96372, 96374
    methylprednisolone (Depo-Medrol) J1040 – Injection, methylprednisolone acetate, 80 mg   11900, 11901, 20600, 20605, 20610, 96372, 96374
    methylprednisolone (Solu-Medrol) J2920 – Injection, methylprednisolone sodium succinate, up to 40 mg   11900, 11901, 20600, 20605, 20610, 96372, 96374
    methylprednisolone (Medrol) J7509 – Methylprednisolone, oral, per 4 mg   N/A
    mitomycin (Mutamycin) J9280 – Mitomycin, 5 mg   96409
    mitoxantrone (Novantrone) J9293 – Injection, mitoxantrone hydrochloride, per 5 mg   96409, 96413
    oxaliplatin (Eloxatin) J9263 – Injection, oxaliplatin, 0.5 mg   96413, 96415
    paclitaxel protein-bound particles (Abraxane) J9264 – Injection, paclitaxel protein-bound particles, 1 mg   96413
    paclitaxel (Taxol) J9265 – Injection, paclitaxel, 30 mg   96413, 96415
    palbociclib (Ibrance) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   N/A
    palbociclib (Ibrance) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
    pemetrexed (Alimta) J9305 – Injection, pemetrexed, 10 mg   96409
    pertuzumab (Perjeta) J9306 – Injection, pertuzumab, 1 mg   96413
    prednisone (eg, Deltasone, Orasone) J7506 – Prednisone, oral, per 5 mg   N/A
    prednisolone (eg, Orapred, Millipred) J7510 – Prednisolone, oral, per 5 mg   N/A
    tamoxifen (Nolvadex) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
    tamoxifen (Nolvadex) S0187 – Tamoxifen citrate, oral, 10 mg   N/A
    thiotepa (Thiotepa) J9340 – Injection, thiotepa, 15 mg   51720, 96409
    topotecan (Hycamtin) J8705 – Topotecan, oral, 0.25 mg   N/A
    topotecan (Hycamtin) J9351 – Injection, topotecan, 0.1 mg   96413
    toremifene (Fareston) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
    trastuzumab (Herceptin) J9355 – Injection, trastuzumab, 10 mg   96413, 96415
    triptorelin (Trelstar) J3315 – Injection, triptorelin pamoate, 3.75 mg   96372, 96402
    vinBLAStine (Velban) J9360 – Injection, vinblastine sulfate, 1 mg   96409
    vinCRIStine (Vincasar PFS) J9370 – Vincristine sulfate, 1 mg   96409
    vinorelbine (Navelbine) J9390 – Injection, vinorelbine tartrate, 10 mg   96409
    zoledronic acid (Reclast, Zometa) J3489 – Injection, zoledronic acid, 1 mg   96365, 96374, 96413
    *When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (ie, J8999 Hydrea) 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 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)
    HCPCS indicates Healthcare Common Procedure Coding System.
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