This detailed article of codes related to brain 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 brain cancer.
The following sections include:
- Associated ICD-10-CM codes used for the classification of brain cancer
- Drugs that have been approved by the FDA for the treatment of brain cancer
- Drugs that are Compendia-listed for off-label use for brain 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
C71 | Malignant neoplasm of Brain | ||
C71.0 | Malignant neoplasm of cerebrum, except lobes and ventricles | ||
C71.1 | Malignant neoplasm of frontal lobe | ||
C71.2 | Malignant neoplasm of temporal lobe | ||
C71.3 | Malignant neoplasm of parietal lobe | ||
C71.4 | Malignant neoplasm of occipital lobe | ||
C71.5 | Malignant neoplasm of cerebral ventricle | ||
C71.6 | Malignant neoplasm of cerebellum | ||
C71.7 | Malignant neoplasm of brain stem | ||
C71.8 | Malignant neoplasm of overlapping sites of brain | ||
C71.9 | Malignant neoplasm of brain, unspecified |
Generic (brand) name | HCPCS code—code description | FDA approved for brain cancer | Compendia off-label uses for brain cancer | Possible CPT® administration codes |
aldesleukin (Proleukin) | J9015 - Injection, aldesleukin, per single-use vial | ✔ | 96409 | |
betamethasone acetate and betamethasone sodium phosphate (Celestone Soluspan) | J0702 - Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg | ✔ | 11900, 11901, 20600, 20605, 20610, 96372 | |
bevacizumab (Avastin) | J9035 - Injection, bevacizumab, 10 mg | ✔ | 96413, 96415 | |
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 | |
cyclophosphamide (Cytoxan) | J8530 - Cyclophosphamide, oral, 25 mg | ✔ | N/A | |
cyclophosphamide (Cytoxan) | J9070 - Cyclophosphamide, 100 mg | ✔ | 96409, 96413, 96415 | |
dexamethasone (Decadron) | J8540 - Dexamethasone, oral, 0.25 mg | ✔ | N/A | |
dexamethasone sodium phosphate (Decadron) | J1100 - Injection, dexamethasone sodium phosphate, 1 mg | ✔ | 11900, 11901, 20600, 20605, 20610, 96372, 96374 | |
etoposide (Vepesid) | J8560 - Etoposide, oral, 50 mg | ✔ | N/A | |
etoposide (Etopophos, Toposar) | J9181 - Injection, etoposide, 10 mg | ✔ | 96413, 96415 | |
everolimus (Afinitor ONLY) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
everolimus (Afinitor ONLY) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
fluorouracil (Adrucil) | J9190 - Injection, fluorouracil, 500 mg | ✔ | 96409 | |
hydrocortisone sodium succinate (Solu-Cortef) | J1720 - Injection, hydrocortisone sodium succinate, up to 100 mg | ✔ | 96365, 96366, 96372, 96374 | |
hydroxyurea (Hydrea) | S0176 - Hydroxyurea, oral, 500 mg | ✔ | N/A | |
hydroxyurea (Hydrea) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
ifosfamide (Ifex) | J9208 - Injection, ifosfamide, 1 g | ✔ | 96413, 96415 | |
irinotecan (Camptosar) | J9206 - Injection, irinotecan, 20 mg | ✔ | 96413, 96415 | |
lomustine (eg, CeeNU, Gleostine) | S0178 - Lomustine, oral, 10 mg | ✔ | N/A | |
lomustine (eg, CeeNU, Gleostine) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
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 | |
methylprednisolone (Depo-Medrol) | J1040 - Injection, methylprednisolone acetate, 80 mg | ✔ | 11900, 11901, 20600, 20605, 20610, 96372 | |
methylprednisolone (Medrol) | J7509 - Methylprednisolone, oral, per 4 mg |
✔ | N/A | |
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 | |
paclitaxel (Taxol) | J9265 - Injection, paclitaxel, 30 mg | ✔ | 96413, 96415 | |
prednisolone (eg, Millipred, Prelone) | J7510 - Prednisolone, oral, per 5 mg | ✔ | N/A | |
prednisone (eg, Deltasone, Orasone) | J7512 - Prednisone, immediate release or delayed release, oral, 1 mg |
✔ | N/A | |
procarbazine (Matulane) | S0182 - Procarbazine hydrochloride, oral, 50 mg |
✔ | N/A | |
procarbazine (Matulane) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
tamoxifen (Nolvadex) | S0187 - Tamoxifen citrate, oral, 10 mg | ✔ | N/A | |
tamoxifen (Nolvadex) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
temozolomide (Temodar) | J8700 - Temozolomide, oral, 5 mg | ✔ | N/A | |
temozolomide (Temodar) | J9328 - Injection, temozolomide, 1 mg | ✔ | 96413, 96415 | |
teniposide (Vumon) | Q2017 - Injection, teniposide, 50 mg | ✔ | 96413, 96415 | |
thiotepa (Thiotepa) | J9340 - Injection, thiotepa, 15 mg | ✔ | 51720, 96409 | |
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 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 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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HCPCS indicates Healthcare Common Procedure Coding System. |