This detailed article of codes related to melanoma (skin 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 melanoma.
The following sections include:
- Associated ICD-10-CM codes used for the classification of melanoma
- Drugs that have been approved by the FDA for the treatment of melanoma
- Drugs that are Compendia-listed for off-label use for melanoma 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
C43 | Malignant melanoma of skin | ||
C43.0 | Malignant melanoma of lip | ||
C43.1 | Malignant melanoma of eyelid, including canthus | ||
C43.10 | Malignant melanoma of unspecified eyelid, including canthus | ||
C43.11 | Malignant melanoma of right eyelid, including canthus | ||
C43.12 | Malignant melanoma of left eyelid, including canthus | ||
C43.2 | Malignant melanoma of ear and external auricular canal | ||
C43.20 | Malignant melanoma of unspecified ear and external auricular canal | ||
C43.21 | Malignant melanoma of right ear and external auricular canal | ||
C43.22 | Malignant melanoma of left ear and external auricular canal | ||
C43.3 | Malignant melanoma of other and unspecified parts of face | ||
C43.30 | Malignant melanoma of unspecified part of face | ||
C43.31 | Malignant melanoma of nose | ||
C43.39 | Malignant melanoma of other parts of face | ||
C43.4 | Malignant melanoma of scalp and neck | ||
C43.5 | Malignant melanoma of trunk | ||
C43.51 | Malignant melanoma of anal skin | ||
C43.52 | Malignant melanoma of skin of breast | ||
C43.59 | Malignant melanoma of other part of trunk | ||
C43.6 | Malignant melanoma of upper limb, including shoulder | ||
C43.60 | Malignant melanoma of unspecified upper limb, including shoulder | ||
C43.61 | Malignant melanoma of right upper limb, including shoulder | ||
C43.62 | Malignant melanoma of left upper limb, including shoulder | ||
C43.7 | Malignant melanoma of lower limb, including hip | ||
C43.70 | Malignant melanoma of unspecified lower limb, including hip | ||
C43.71 | Malignant melanoma of right lower limb, including hip | ||
C43.72 | Malignant melanoma of left lower limb, including hip | ||
C43.8 | Malignant melanoma of overlapping sites of skin | ||
C43.9 | Malignant melanoma of skin, unspecified |
Generic (brand) name | HCPCS code—code description | FDA approved for melanoma (skin cancer) | Compendia off-label uses for melanoma (skin cancer) | Possible CPT® administration codes |
aldesleukin (Proleukin) | J9015 - Injection, aldesleukin, per single-use vial | ✔ | 96409 | |
amifostine (Ethyol) | J0207 - Injection, amifostine, 500 mg | ✔ | 96374 | |
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 | |
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 | |
cobimetinib (Cotellic) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
cobimetinib (Cotellic) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
dabrafenib (Tafinlar) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
dabrafenib (Tafinlar) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
dacarbazine (DTIC-Dome) | J9130 - Dacarbazine, 100 mg | ✔ | 96409, 96413 | |
dactinomycin (Cosmegen) | J9120 - Injection, dactinomycin, 0.5 mg | ✔ | 96409 | |
docetaxel (Taxotere) | J9171 - Injection, docetaxel, 1 mg | ✔ | 96413 | |
interferon alfa-2b (Intron-A) | J9214 - Injection, interferon, alfa-2b, recombinant, 1 million units | ✔ | 96372, 96401 | |
ipilimumab (Yervoy) | J9228 - Injection, ipilimumab, 1 mg | ✔ | 96413, 96415 | |
lomustine (CeeNu) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
lomustine (CeeNu) | S0178 - Lomustine, oral, 10 mg | ✔ | N/A | |
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) | J9245 - Injection, melphalan hydrochloride, 50 mg | ✔ | 96409, 96413 | |
nivolumab (Opdivo) | J9299 - Injection, nivolumab, 1 mg | ✔ | 96413, 96415 | |
paclitaxel (Taxol) | J9267 - Injection, paclitaxel, 1 mg | ✔ | 96413, 96415 | |
peginterferon alfa-2b (Sylatron) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | 96372, 96401 | |
peginterferon alfa-2b (Sylatron) | J9999* - Not otherwise classified, antineoplastic drugs | ✔ | 96372, 96401 | |
pembrolizumab (Keytruda) | J9271 - Injection, pembrolizumab, 1 mg | ✔ | 96413 | |
sargramostim (Leukine) | J2820 - Injection, sargramostim (GM-CSF), 50 mcg | ✔ | 96365, 96366, 96372 | |
talimogene laherparepvec (Imlygic) | J9325 - Injection, talimogene laherparepvec, per 1 million plaque- forming units | ✔ | 96405, 96406 | |
temozolomide (Temodar) | J8700 - Temozolomide, oral, 5 mg | ✔ | N/A | |
trametinib (Mekinist) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
trametinib (Mekinist) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
vemurafenib (Zelboraf) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
vemurafenib (Zelboraf) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
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 Zelboraf) 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. | ||||
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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GM-CSF indicates granulocyte-macrophage colony-stimulating factor; HCPCS, Healthcare Common Procedure Coding System. |