Bristol Myers Squibb is committed to helping appropriate patients get access to our
medications by providing access and reimbursement support services.

This information is intended for U.S. healthcare professionals and/or healthcare professionals involved in healthcare reimbursement.

ABRAXANE®
for Injectable Suspension (paclitaxel protein-bound particles for injectable suspension) (albumin-bound)

Charitable Foundations
Resource

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
Download


Filter by keyword Clear Filter
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

COPY

Injection, paclitaxel protein-bound particles, 1 mg

Revenue Codes (for Use in the Hospital Outpatient Setting)2
0250

COPY

General pharmacy

0258

COPY

IV solutions; administration

0260

COPY

IV therapy (required by Medicare for separate billable drugs)

0636

COPY

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

Current Procedural Terminology (CPT)3,†
96413

COPY

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

COPY

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

COPY

Malignant neoplasm of breast

C50.0

COPY

Malignant neoplasm of nipple and areola

C50.01

COPY

Malignant neoplasm of nipple and areola, female

C50.011

COPY

Malignant neoplasm of nipple and areola, right female breast

C50.012

COPY

Malignant neoplasm of nipple and areola, left female breast

C50.019

COPY

Malignant neoplasm of nipple and areola, unspecified female breast

C50.1

COPY

Malignant neoplasm of central portion of breast

C50.11

COPY

Malignant neoplasm of central portion of breast, female

C50.111

COPY

Malignant neoplasm of central portion of right female breast

C50.112

COPY

Malignant neoplasm of central portion of left female breast

C50.119

COPY

Malignant neoplasm of central portion of unspecified female breast

C50.2

COPY

Malignant neoplasm of upper-inner quadrant of breast

C50.21

COPY

Malignant neoplasm of upper-inner quadrant of breast, female

C50.211

COPY

Malignant neoplasm of upper-inner quadrant of right female breast

C50.212

COPY

Malignant neoplasm of upper-inner quadrant of left female breast

C50.219

COPY

Malignant neoplasm of upper-inner quadrant of unspecified female breast

C50.3

COPY

Malignant neoplasm of lower-inner quadrant of breast

C50.31

COPY

Malignant neoplasm of lower-inner quadrant of breast, female

C50.311

COPY

Malignant neoplasm of lower-inner quadrant of right female breast

C50.312

COPY

Malignant neoplasm of lower-inner quadrant of left female breast

C50.319

COPY

Malignant neoplasm of lower-inner quadrant of unspecified female breast

C50.4

COPY

Malignant neoplasm of upper-outer quadrant of breast

C50.41

COPY

Malignant neoplasm of upper-outer quadrant of breast, female

C50.411

COPY

Malignant neoplasm of upper-outer quadrant of right female breast

C50.412

COPY

Malignant neoplasm of upper-outer quadrant of left female breast

C50.419

COPY

Malignant neoplasm of upper-outer quadrant of unspecified female breast

C50.5

COPY

Malignant neoplasm of lower-outer quadrant of breast

C50.51

COPY

Malignant neoplasm of lower-outer quadrant of breast, female

C50.511

COPY

Malignant neoplasm of lower-outer quadrant of right female breast

C50.512

COPY

Malignant neoplasm of lower-outer quadrant of left female breast

C50.519

COPY

Malignant neoplasm of lower-outer quadrant of unspecified female breast

C50.6

COPY

Malignant neoplasm of axillary tail of breast

C50.61

COPY

Malignant neoplasm of axillary tail of breast, female

C50.611

COPY

Malignant neoplasm of axillary tail of right female breast

C50.612

COPY

Malignant neoplasm of axillary tail of left female breast

C50.619

COPY

Malignant neoplasm of axillary tail of unspecified female breast

C50.8

COPY

Malignant neoplasm of overlapping sites of breast

C50.81

COPY

Malignant neoplasm of overlapping sites of breast, female

C50.811

COPY

Malignant neoplasm of overlapping sites of right female breast

C50.812

COPY

Malignant neoplasm of overlapping sites of left female breast

C50.819

COPY

Malignant neoplasm of overlapping sites of unspecified female breast

C50.9

COPY

Malignant neoplasm of breast of unspecified site

C50.91

COPY

Malignant neoplasm of breast of unspecified site, female

C50.911

COPY

Malignant neoplasm of unspecified site of right female breast

C50.912

COPY

Malignant neoplasm of unspecified site of left female breast

C50.919

COPY

Malignant neoplasm of unspecified site of unspecified female breast

C50.02

COPY

Malignant neoplasm of nipple and areola, male

C50.021

COPY

Malignant neoplasm of nipple and areola, right male breast

C50.022

COPY

Malignant neoplasm of nipple and areola, left male breast

C50.029

COPY

Malignant neoplasm of nipple and areola, unspecified male breast

C50.1

COPY

Malignant neoplasm of central portion of breast

C50.12

COPY

Malignant neoplasm of central portion of breast, male

C50.121

COPY

Malignant neoplasm of central portion of right male breast

C50.122

COPY

Malignant neoplasm of central portion of left male breast

C50.129

COPY

Malignant neoplasm of central portion of unspecified male breast

C50.2

COPY

Malignant neoplasm of upper-inner quadrant of breast

C50.22

COPY

Malignant neoplasm of upper-inner quadrant of breast, male

C50.221

COPY

Malignant neoplasm of upper-inner quadrant of right male breast

C50.222

COPY

Malignant neoplasm of upper-inner quadrant of left male breast

C50.229

COPY

Malignant neoplasm of upper-inner quadrant of unspecified male breast

C50.3

COPY

Malignant neoplasm of lower-inner quadrant of breast

C50.32

COPY

Malignant neoplasm of lower-inner quadrant of breast, male

C50.321

COPY

Malignant neoplasm of lower-inner quadrant of right male breast

C50.322

COPY

Malignant neoplasm of lower-inner quadrant of left male breast

C50.329

COPY

Malignant neoplasm of lower-inner quadrant of unspecified male breast

C50.4

COPY

Malignant neoplasm of upper-outer quadrant of breast

C50.42

COPY

Malignant neoplasm of upper-outer quadrant of breast, male

C50.421

COPY

Malignant neoplasm of upper-outer quadrant of right male breast

C50.422

COPY

Malignant neoplasm of upper-outer quadrant of left male breast

C50.429

COPY

Malignant neoplasm of upper-outer quadrant of unspecified male breast

C50.5

COPY

Malignant neoplasm of lower-outer quadrant of breast

C50.52

COPY

Malignant neoplasm of lower-outer quadrant of breast, male

C50.521

COPY

Malignant neoplasm of lower-outer quadrant of right male breast

C50.522

COPY

Malignant neoplasm of lower-outer quadrant of left male breast

C50.529

COPY

Malignant neoplasm of lower-outer quadrant of unspecified male breast

C50.6

COPY

Malignant neoplasm of axillary tail of breast

C50.62

COPY

Malignant neoplasm of axillary tail of breast, male

C50.621

COPY

Malignant neoplasm of axillary tail of right male breast

C50.622

COPY

Malignant neoplasm of axillary tail of left male breast

C50.629

COPY

Malignant neoplasm of axillary tail of unspecified male breast

C50.8

COPY

Malignant neoplasm of overlapping sites of breast

C50.82

COPY

Malignant neoplasm of overlapping sites of breast, male

C50.821

COPY

Malignant neoplasm of overlapping sites of right male breast

C50.822

COPY

Malignant neoplasm of overlapping sites of left male breast

C50.829

COPY

Malignant neoplasm of overlapping sites of unspecified male breast

C50.9

COPY

Malignant neoplasm of breast of unspecified site

C50.92

COPY

Malignant neoplasm of breast of unspecified site, male

C50.921

COPY

Malignant neoplasm of unspecified site of right male breast

C50.922

COPY

Malignant neoplasm of unspecified site of left male breast

C50.929

COPY

Malignant neoplasm of unspecified site of unspecified male breast

Advanced Non-Small Cell Lung Cancer ICD-10 Codes
C34.1

COPY

Malignant neoplasm of upper lobe, bronchus or lung

C34.10

COPY

Malignant neoplasm of upper lobe, unspecified bronchus or lung

C34.11

COPY

Malignant neoplasm of upper lobe, right bronchus or lung

C34.12

COPY

Malignant neoplasm of upper lobe, left bronchus or lung

C34.2

COPY

Malignant neoplasm of middle lobe, bronchus or lung

C34.3

COPY

Malignant neoplasm of lower lobe, bronchus or lung

C34.30

COPY

Malignant neoplasm of lower lobe, unspecified bronchus or lung

C34.31

COPY

Malignant neoplasm of lower lobe, right bronchus or lung

C34.32

COPY

Malignant neoplasm of lower lobe, left bronchus or lung

C34.8

COPY

Malignant neoplasm of overlapping sites of bronchus and lung

C34.80

COPY

Malignant neoplasm of overlapping sites of unspecified bronchus and lung

C34.81

COPY

Malignant neoplasm of overlapping sites of right bronchus and lung

C34.82

COPY

Malignant neoplasm of overlapping sites of left bronchus and lung

C34.9

COPY

Malignant neoplasm of unspecified part of bronchus or lung

C34.90

COPY

Malignant neoplasm of unspecified part of unspecified bronchus or lung

C34.91

COPY

Malignant neoplasm of unspecified part of right bronchus or lung

C34.92

COPY

Malignant neoplasm of unspecified part of left bronchus or lung

Metastatic Pancreatic Adenocarcinoma ICD-10 Codes
C25

COPY

Malignant neoplasm of pancreas

C25.0

COPY

Malignant neoplasm of head of pancreas

C25.1

COPY

Malignant neoplasm of body of pancreas

C25.2

COPY

Malignant neoplasm of tail of pancreas

C25.3

COPY

Malignant neoplasm of pancreatic duct

C25.4

COPY

Malignant neoplasm of endocrine pancreas

C25.7

COPY

Malignant neoplasm of other parts of pancreas

C25.8

COPY

Malignant neoplasm of overlapping sites of pancreas

C25.9

COPY

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:

  1. American Medical Association. 2020 HCPCS Level II. Professional ed. Chicago, IL: American Medical Association; 2020.
  2. 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.
  3. American Medical Association. CPT Professional 2020. Professional ed. Chicago, IL: American Medical Association; 2019.
  4. ABRAXANE for Injectable Suspension (paclitaxel protein-bound particles for injectable suspension) (albumin-bound) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  5. 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.

Support Center icon
Support Center: 1-800-861-0048
am to 8 pm ET, Mon - Fri
Schedule a Call icon
Schedule a call from a Patient Access SpecialistSchedule a Call >
Request a Visit icon
Request a visit from a BMS Access & Reimbursement ManagerRequest a Visit >
Schedule a Call Request a Visit
BMS Logo

©2022 Bristol-Myers Squibb Company. Access Support is a registered trademark of Bristol-Myers Squibb Company. ABRAXANE® is a registered trademark of Abraxis BioScience, LLC. Abraxis BioScience, LLC is a wholly owned subsidiary of Bristol-Myers Squibb Company.

Use of the information on this site is subject to the terms of our Legal Notice and Privacy Statement. The coding, coverage, and payment information contained within this website is current as of 06/22.

2013-US-2100058 06/22