This detailed article of codes related to bladder 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 bladder cancer.
The following sections include:
- Associated ICD-10-CM codes used for the classification of bladder cancer
- Drugs that have been approved by the FDA for the treatment of bladder cancer
- Drugs that are Compendia-listed for off-label use for bladder 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
| C67 | Malignant neoplasm of bladder | ||
| C67.0 | Malignant neoplasm of trigone of bladder | ||
| C67.1 | Malignant neoplasm of dome of bladder | ||
| C67.2 | Malignant neoplasm of lateral wall of bladder | ||
| C67.3 | Malignant neoplasm of anterior wall of bladder | ||
| C67.4 | Malignant neoplasm of posterior wall of bladder | ||
| C67.5 | Malignant neoplasm of bladder neck | ||
| C67.6 | Malignant neoplasm of ureteric orifice | ||
| C67.7 | Malignant neoplasm of urachus | ||
| C67.8 | Malignant neoplasm of overlapping sites of bladder | ||
| C67.9 | Malignant neoplasm of bladder, unspecified | ||
| Generic (brand) name | HCPCS code—code description | FDA approved for bladder cancer | Compendia off-label uses for bladder cancer | Possible CPT® administration codes |
| atezolizumab (Tecentriq) | C9483 - Injection, atezolizumab, 10 mg | ✔ | 96413, 96415 | |
| atezolizumab (Tecentriq) | J9999 - Not otherwise classified, antineoplastic drugs | ✔ | 96413, 96415 | |
| bacillus Calmette-Guérin (TheraCys, Tice BCG) | 90586 - Bacillus Calmette-Guérin (BCG) vaccine for bladder cancer, live, for intravesical use | ✔ | 51720 | |
| 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 | |
| docetaxel (Taxotere) | J9171 - Injection, docetaxel, 1 mg | ✔ | 96413 | |
| doxorubicin HCl (Adriamycin) | J9000 - Injection, doxorubicin hydrochloride, 10 mg | ✔ | 96409 | |
| epirubicin (Ellence) | J9178 - Injection, epirubicin hydrochloride, 2 mg | ✔ | 96409, 96413 | |
| fluorouracil (Adrucil) | J9190 - Injection, fluorouracil, 500 mg | ✔ | 96409 | |
| gemcitabine (Gemzar) | J9201 - Injection, gemcitabine hydrochloride, 200 mg | ✔ | 96413 | |
| ifosfamide (Ifex) | J9208 - Injection, ifosfamide, 1 gram | ✔ | 96413, 96415 | |
| interferon alfa-2b (Intron-A) | J9214 - Injection, interferon alfa-2b, recombinant, 1 million units | ✔ | 96372, 96401 | |
| methotrexate | J9250 - Methotrexate sodium, 5 mg | ✔ | 96372, 96374, 96401, 96409, 96450 | |
| methotrexate | J9260 - Methotrexate sodium, 50 mg | ✔ | 96372, 96374, 96401, 96409, 96450 | |
| mitomycin (Mutamycin) | J9280 - Mitomycin, 5 mg | ✔ | 96409 | |
| mitoxantrone (Novantrone) | J9293 - Injection, mitoxantrone hydrochloride, 5 mg | ✔ | 96409, 96413 | |
| paclitaxel (Taxol) | J9265 - Injection, paclitaxel, 30 mg | ✔ | 96413, 96415 | |
| pemetrexed (Alimta) | J9305 - Injection, pemetrexed, 10 mg | ✔ | 96409 | |
| porfimer sodium (Photofrin) | J9600 - Injection, porfimer sodium, 75 mg | ✔ | 96409 | |
| tamoxifen (Nolvadex) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
| tamoxifen (Nolvadex) | S0187 - Tamoxifen citrate, oral, 10 mg | ✔ | N/A | |
| 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 | |
| valrubicin (Valstar) | J9357 - Injection, valrubicin, intravesical, 200 mg | ✔ | 51720 | |
| *When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (eg, J9999 Tecentriq) 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. | ||||
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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) |
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| HCPCS indicates Healthcare Common Procedure Coding System. | ||||