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

Kristin A. Esposito, CPhT

September 2017, Vol 7, No 9 - ICD Codes


This detailed article of codes related to prostate 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 prostate cancer.

The following sections include:

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

C61 Malignant neoplasm of prostate
Generic (brand) name HCPCS code—code description FDA approved for prostate cancer Compendia off-label uses for prostate cancer Possible CPT® administration codes
abiraterone acetate (Zytiga) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
abiraterone acetate (Zytiga) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   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) 90586 – Bacillus Calmette-Guérin vaccine (BCG) for bladder cancer, live, for intravesical use   51720
bacillus Calmette-Guérin (Tice BCG) J9031 – bCG (intravesical), per installation   51720
bevacizumab (Avastin) J9035 – Injection, bevacizumab, 10 mg   96413, 96415
bicalutamide (Casodex) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
cabazitaxel (Jevtana) J9043 – Injection, cabazitaxel, 1 mg   96413
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
degarelix (Firmagon) J9155 – Injection, degarelix, 1 mg   96402
dexamethasone (Decadron) J8540 – Dexamethasone, oral, 0.25 mg   N/A
docetaxel (Taxotere, Docefrez) J9171 – Injection, docetaxel, 1 mg   96413
enzalutamide (Xtandi) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   N/A
enzalutamide (Xtandi) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
epirubicin (Ellence) J9178 – Injection, epirubicin hydrochloride, 2 mg   96409, 96413
estradiol valerate (Delestrogen) J1380 – Injection, estradiol valerate, up to 10 mg   96372
estramustine (Emcyt) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
estrogen (eg, estradiol, conjugated estrogen, esterified estrogen) J8499* – Prescription drug, oral, nonchemotherapeutic, not otherwise specified   N/A
finasteride (eg, Proscar) S0138 – Finasteride, 5 mg   N/A
flutamide (Eulexin) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
flutamide (Eulexin) S0175 – Flutamide, oral, 125 mg   N/A
goserelin acetate (Zoladex) J9202 – Goserelin acetate implant, per 3.6 mg   96372, 96402
histrelin (Vantas) J9225 – Histrelin implant (Vantas), 50 mg   11981, 11982, 11983
ixabepilone (Ixempra) J9207 – Injection, ixabepilone, 1 mg   96413, 96415
ketoconazole (Nizoral) J8499* – Prescription drug, oral, nonchemotherapeutic, not otherwise specified   N/A
leuprolide acetate (Eligard, Lupron Depot) J9217 – Leuprolide acetate (for depot suspension), 7.5 mg   96402
leuprolide acetate (Lupron) J9218 – Leuprolide acetate, per 1 mg   96402
medroxyprogesterone (Depo-Provera) J1050 – Injection, medroxyprogesterone acetate, 1 mg   96372, 96402
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) 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) J2920 – Injection, methylprednisolone sodium succinate, up to 40 mg   96365, 96366, 96372, 96374
methylprednisolone (Solu-Medrol) J2930 – Injection, methylprednisolone sodium succinate, up to 125 mg   96365, 96366, 96372, 96374
mitoxantrone (Novantrone) J9293 – Injection, mitoxantrone hydrochloride, per 5 mg   96409, 96413
nilutamide (Nilandron) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
paclitaxel (Taxol) J9267 – Injection, paclitaxel, 1 mg   96413, 96415
prednisolone (eg, Orapred, Millipred) J7510 – Prednisolone, oral, per 5 mg   N/A
prednisone (Deltasone) J7512 – Prednisone, immediate release or delayed release, oral, 1 mg   N/A
radium Ra dichloride (Xofigo) A9606 – Radium Ra-223 dichloride, therapeutic, per microcurie   79101
sipuleucel-T (Provenge) Q2043 – Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion (Code Price is per 250 mL)   96413, 96415
topotecan (Hycamtin) J9351 – Injection, topotecan, 0.1 mg   96413
trastuzumab (Herceptin) J9355 – Injection, trastuzumab, 10 mg   96413, 96415
triptorelin (Trelstar Depot, Trelstar) J3315 – Injection, triptorelin pamoate, 3.75 mg   96372, 96402
vinBLAStine (Velban) J9360 – Injection, vinblastine sulfate, 1 mg   96409
vinorelbine (Navelbine) J9390 – Injection, vinorelbine tartrate, per 10 mg   96409
*When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (eg, J8999 Zytiga) in Item 24D and the drug name, strength, and NDC (National Drug Code) in Item 19 or 24A shaded area in order to ensure appropriate reimbursement.
Please note: Check with payer regarding correct placement of medication information.
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)
HCPCS indicates Healthcare Common Procedure Coding System; PAP-GM-CSF, prostatic acid phosphatase granulocyte-macrophage colony-stimulating factor.