Billing and
Diagnosis Codes

The accurate completion of reimbursement- or coverage-related documentation is the
responsibility of the healthcare provider and patient. Bristol Myers Squibb and its agents make no
guarantee regarding reimbursement for any service or item.

Reimbursement and Coding Guide for ABRAXANE
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Codes*
Distribution
FDA Letters

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Type a keyword to find a specific HCPCS, CPT, NDC, or ICD-10 code for Breast, Lung, or Pancreatic Cancer

Healthcare Common Procedure Coding System (HCPCS) Code¹ Issued by CMS

J9264

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Injection, paclitaxel protein-bound particles, 1 mg

Revenue Codes (for Use in the Hospital Outpatient Setting)²

0250

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General pharmacy

0258

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IV solutions; administration

0260

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IV therapy (required by Medicare for separate billable drugs)

0636

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Drugs requiring detailed coding; may be used to specify the drug given

Current Procedural Terminology (CPT)^3,†

96413

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Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

National Drug Codes (NDC)⁴Issued by the FDA

68817-0134-50

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100 mg of paclitaxel in a single-dose vial, individually packaged in a carton

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)⁵

Metastatic Breast Cancer ICD-10 Codes

C50

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Malignant neoplasm of breast

C50.0

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Malignant neoplasm of nipple and areola

C50.01

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Malignant neoplasm of nipple and areola, female

C50.011

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Malignant neoplasm of nipple and areola, right female breast

C50.012

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Malignant neoplasm of nipple and areola, left female breast

C50.019

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Malignant neoplasm of nipple and areola, unspecified female breast

C50.1

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Malignant neoplasm of central portion of breast

C50.11

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Malignant neoplasm of central portion of breast, female

C50.111

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Malignant neoplasm of central portion of right female breast

C50.112

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Malignant neoplasm of central portion of left female breast

C50.119

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Malignant neoplasm of central portion of unspecified female breast

C50.2

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Malignant neoplasm of upper-inner quadrant of breast

C50.21

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Malignant neoplasm of upper-inner quadrant of breast, female

C50.211

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Malignant neoplasm of upper-inner quadrant of right female breast

C50.212

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Malignant neoplasm of upper-inner quadrant of left female breast

C50.219

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Malignant neoplasm of upper-inner quadrant of unspecified female breast

C50.3

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Malignant neoplasm of lower-inner quadrant of breast

C50.31

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Malignant neoplasm of lower-inner quadrant of breast, female

C50.311

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Malignant neoplasm of lower-inner quadrant of right female breast

C50.312

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Malignant neoplasm of lower-inner quadrant of left female breast

C50.319

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Malignant neoplasm of lower-inner quadrant of unspecified female breast

C50.4

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Malignant neoplasm of upper-outer quadrant of breast

C50.41

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Malignant neoplasm of upper-outer quadrant of breast, female

C50.411

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Malignant neoplasm of upper-outer quadrant of right female breast

C50.412

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Malignant neoplasm of upper-outer quadrant of left female breast

C50.419

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Malignant neoplasm of upper-outer quadrant of unspecified female breast

C50.5

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Malignant neoplasm of lower-outer quadrant of breast

C50.51

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Malignant neoplasm of lower-outer quadrant of breast, female

C50.511

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Malignant neoplasm of lower-outer quadrant of right female breast

C50.512

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Malignant neoplasm of lower-outer quadrant of left female breast

C50.519

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Malignant neoplasm of lower-outer quadrant of unspecified female breast

C50.6

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Malignant neoplasm of axillary tail of breast

C50.61

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Malignant neoplasm of axillary tail of breast, female

C50.611

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Malignant neoplasm of axillary tail of right female breast

C50.612

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Malignant neoplasm of axillary tail of left female breast

C50.619

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Malignant neoplasm of axillary tail of unspecified female breast

C50.8

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Malignant neoplasm of overlapping sites of breast

C50.81

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Malignant neoplasm of overlapping sites of breast, female

C50.811

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Malignant neoplasm of overlapping sites of right female breast

C50.812

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Malignant neoplasm of overlapping sites of left female breast

C50.819

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Malignant neoplasm of overlapping sites of unspecified female breast

C50.9

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Malignant neoplasm of breast of unspecified site

C50.91

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Malignant neoplasm of breast of unspecified site, female

C50.911

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Malignant neoplasm of unspecified site of right female breast

C50.912

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Malignant neoplasm of unspecified site of left female breast

C50.919

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Malignant neoplasm of unspecified site of unspecified female breast

C50.02

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Malignant neoplasm of nipple and areola, male

C50.021

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Malignant neoplasm of nipple and areola, right male breast

C50.022

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Malignant neoplasm of nipple and areola, left male breast

C50.029

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Malignant neoplasm of nipple and areola, unspecified male breast

C50.1

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Malignant neoplasm of central portion of breast

C50.12

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Malignant neoplasm of central portion of breast, male

C50.121

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Malignant neoplasm of central portion of right male breast

C50.122

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Malignant neoplasm of central portion of left male breast

C50.129

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Malignant neoplasm of central portion of unspecified male breast

C50.2

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Malignant neoplasm of upper-inner quadrant of breast

C50.22

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Malignant neoplasm of upper-inner quadrant of breast, male

C50.221

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Malignant neoplasm of upper-inner quadrant of right male breast

C50.222

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Malignant neoplasm of upper-inner quadrant of left male breast

C50.229

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Malignant neoplasm of upper-inner quadrant of unspecified male breast

C50.3

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Malignant neoplasm of lower-inner quadrant of breast

C50.32

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Malignant neoplasm of lower-inner quadrant of breast, male

C50.321

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Malignant neoplasm of lower-inner quadrant of right male breast

C50.322

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Malignant neoplasm of lower-inner quadrant of left male breast

C50.329

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Malignant neoplasm of lower-inner quadrant of unspecified male breast

C50.4

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Malignant neoplasm of upper-outer quadrant of breast

C50.42

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Malignant neoplasm of upper-outer quadrant of breast, male

C50.421

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Malignant neoplasm of upper-outer quadrant of right male breast

C50.422

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Malignant neoplasm of upper-outer quadrant of left male breast

C50.429

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Malignant neoplasm of upper-outer quadrant of unspecified male breast

C50.5

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Malignant neoplasm of lower-outer quadrant of breast

C50.52

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Malignant neoplasm of lower-outer quadrant of breast, male

C50.521

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Malignant neoplasm of lower-outer quadrant of right male breast

C50.522

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Malignant neoplasm of lower-outer quadrant of left male breast

C50.529

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Malignant neoplasm of lower-outer quadrant of unspecified male breast

C50.6

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Malignant neoplasm of axillary tail of breast

C50.62

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Malignant neoplasm of axillary tail of breast, male

C50.621

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Malignant neoplasm of axillary tail of right male breast

C50.622

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Malignant neoplasm of axillary tail of left male breast

C50.629

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Malignant neoplasm of axillary tail of unspecified male breast

C50.8

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Malignant neoplasm of overlapping sites of breast

C50.82

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Malignant neoplasm of overlapping sites of breast, male

C50.821

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Malignant neoplasm of overlapping sites of right male breast

C50.822

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Malignant neoplasm of overlapping sites of left male breast

C50.829

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Malignant neoplasm of overlapping sites of unspecified male breast

C50.9

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Malignant neoplasm of breast of unspecified site

C50.92

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Malignant neoplasm of breast of unspecified site, male

C50.921

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Malignant neoplasm of unspecified site of right male breast

C50.922

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Malignant neoplasm of unspecified site of left male breast

C50.929

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Malignant neoplasm of unspecified site of unspecified male breast

Advanced Non-Small Cell Lung Cancer ICD-10 Codes

C34.1

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Malignant neoplasm of upper lobe, bronchus or lung

C34.10

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Malignant neoplasm of upper lobe, unspecified bronchus or lung

C34.11

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Malignant neoplasm of upper lobe, right bronchus or lung

C34.12

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Malignant neoplasm of upper lobe, left bronchus or lung

C34.2

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Malignant neoplasm of middle lobe, bronchus or lung

C34.3

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Malignant neoplasm of lower lobe, bronchus or lung

C34.30

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Malignant neoplasm of lower lobe, unspecified bronchus or lung

C34.31

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Malignant neoplasm of lower lobe, right bronchus or lung

C34.32

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Malignant neoplasm of lower lobe, left bronchus or lung

C34.8

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Malignant neoplasm of overlapping sites of bronchus and lung

C34.80

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Malignant neoplasm of overlapping sites of unspecified bronchus and lung

C34.81

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Malignant neoplasm of overlapping sites of right bronchus and lung

C34.82

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Malignant neoplasm of overlapping sites of left bronchus and lung

C34.9

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Malignant neoplasm of unspecified part of bronchus or lung

C34.90

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Malignant neoplasm of unspecified part of unspecified bronchus or lung

C34.91

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Malignant neoplasm of unspecified part of right bronchus or lung

C34.92

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Malignant neoplasm of unspecified part of left bronchus or lung

Metastatic Pancreatic Adenocarcinoma ICD-10 Codes

C25

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Malignant neoplasm of pancreas

C25.0

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Malignant neoplasm of head of pancreas

C25.1

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Malignant neoplasm of body of pancreas

C25.2

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Malignant neoplasm of tail of pancreas

C25.3

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Malignant neoplasm of pancreatic duct

C25.4

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Malignant neoplasm of endocrine pancreas

C25.7

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Malignant neoplasm of other parts of pancreas

C25.8

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Malignant neoplasm of overlapping sites of pancreas

C25.9

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Malignant neoplasm of pancreas, unspecified

Coding for ABRAXANE is dependent on the insurer and the care setting in which the drug will be administered. Oncology practices need to make coding decisions based on the diagnosis and treatment of each patient and the specific insurer requirements.

Please see U.S. Full Prescribing Information for ABRAXANE, including Boxed WARNING.

*Healthcare providers should code healthcare claims based upon the service that is rendered, the patient’s medical record, the coding requirements of each health insurer, and best coding practices. Coding guidance provided under this heading does not provide a guarantee of reimbursement and should be considered together with all applicable coding guidance and standards. All of the coding information presented by this website is applicable to outpatient procedures only.

^†CPT codes and descriptions only are ©2019 by American Medical Association (AMA). All rights reserved. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association.

References:

American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
Palmetto GBA. Medicare Part A Billing Guide. May 2017. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/ Part_A_Billing_Guide.pdf/$File/Part_A_Billing_Guide.pdf. Accessed March 10, 2022.
American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
ABRAXANE for Injectable Suspension (paclitaxel protein-bound particles for injectable suspension) (albumin-bound) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM. Accessed March 10, 2022.

ABRAXANE may be purchased through the distributors listed below.

Specialty Distributor	Phone Orders	Fax Orders and Website
ASD Healthcare	1-800-746-6273	Fax: 1-800-547-9413 https://www.asd healthcare.com
Cardinal Health Specialty Pharmaceutical Distribution	1-877-453-3972	https://specialty online.cardinal health.com
CuraScript Specialty Distribution	1-877-599-7748	https://www.cura scriptsd.com
McKesson Plasma and Biologics	1-877-625-2566	Fax: 1-888-752-7626 https://connect. mckesson.com
McKesson Specialty	1-800-482-6700	https://mscs. mckesson.com
Morris & Dickson Specialty	1-800-710-6100	Fax: 1-318-524-3096 https://www.mds pecialtydist.com
Oncology Supply	1-800-633-7555	https://www. oncologysupply .com

Wholesalers	Phone Orders	Fax Orders and Website
AmerisourceBergen Corporation	1-844-222-2273	https://abcorder. amerisource bergen.com
Cardinal Health Inc.	1-800-964-5227	https://www.card inalhealth.com/ en/login.html
DMS Pharmaceutical Group, Inc.	1-877-788-1100	Fax: 1-847-518-1105 https://www.dms pharma.com
McKesson Corporation	1-855-625-7385 (independent chain pharmacies) 1-855-625-6285 (retail account) 1-855-625-4677 (hospitals and health systems)	https://connect. mckesson.com
Morris & Dickson Co., LLC	1-800-388-3833	https://www.md webportal.net
N.C. Mutual Wholesale Drug Co.	1-800-800-8551	https://orders. mutualdrug.com
Smith Drug Company Div Jm Smith Corporation	1-800-542-1216	https://egate. smithdrug.com/

Puerto Rico Hospitals and Oncology Clinics

Authorized Distributor	Phone Orders	Fax Orders and Website
Cardinal Puerto Rico (Borschow)	1-787-625-4200	https://orderexpress.cardinalhealth.com
Cesar Castillo Inc.	1-787-641-5242 (Hospitals) 1-787-641-5082 (Specialty Pharmacies)	Fax: 1-787-999-1614 https://www.facilfarmaciacci.com

Above information is accurate as of 06/22.

The ABRAXANE distribution program includes extended payment terms to Bristol Myers Squibb authorized ABRAXANE distributors. Healthcare providers and institutions should contact their ABRAXANE distributor to understand specific payment terms that may be available to them from their distributor.

Please see U.S. Full Prescribing Information for ABRAXANE, including Boxed WARNING.

FDA Approval Letters as Posted by the FDA:

For the treatment of metastatic breast cancer after failure of combination chemotherapy for metastatic disease or relapse within 6 months of adjuvant chemotherapy. Prior therapy should have included an anthracycline unless clinically contraindicated
View Letter

For the first-line treatment of locally advanced or metastatic non–small cell lung cancer, in combination with carboplatin, in patients who are not candidates for curative surgery or radiation therapy
View Letter

For the first-line treatment of patients with metastatic adenocarcinoma of the pancreas, in combination with gemcitabine
View Letter

Please see U.S. Full Prescribing Information for ABRAXANE, including Boxed WARNING.

The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.