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Billing and Coding

Correct coding is the responsibility of the provider submitting a claim for the item or service. Here we provide general billing and coding information for ALOXI® (palonosetron HCI injection) and related services. Please check with the payor to verify coding or special billing requirements.

International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes

ALOXI® (palonosetron HCI injection) is an anti-nausea medication also known as an antiemetic. In adults, ALOXI® is used to help prevent symptoms of chemotherapy-induced nausea and vomiting (CINV) in a single intravenous (IV) dose by blocking the effects of serotonin.

Providers should use current ICD-10-CM codes to report a patient's diagnosis on claim submissions. Below is a list of ICD-10-CM diagnosis codes that may be reasonably related to a diagnosis within the product's approved label. Other codes may be appropriate.

Correct coding is the responsibility of the provider submitting a claim for the item or service. Please see FDA approved indications for ALOXI® (palonosetron HCI injection) and check with the payor to verify coding or special billing requirements.

ICD-10-CM Diagnosis Code

Title

R11.2

Nausea with vomiting; unspecified

R11.0

Nausea

R11.10

Vomiting, unspecified

R11.11

Vomiting without nausea

R11.12

Projectile vomiting

We recommend verifying a health plan's coding policies. The Eisai Assistance Program can provide information to patients and healthcare professionals relating to payor-specific policies and can address other questions at: 1-866-61-EISAI (1-866-613-4724).

International Classification of Diseases, Tenth Revision (ICD-10) Supplementary Classification Codes

Supplemental classification codes permit the reporting of circumstances and conditions that impact the disease or injury. When providers use supplementary ICD-10-CM codes, they should also report a diagnosis code from one of the main chapters of ICD-10-CM, indicating the nature of the condition.

Below are ICD-10-CM supplementary classification codes that may be reasonably related to a diagnosis within the product's approved label. Other codes may be appropriate.

Correct coding is the responsibility of the provider submitting a claim for the item or service. Please see FDA approved indications for ALOXI® and check with the payor to verify coding or special billing requirements.

ICD-10 CM

Description

T45.1X5

Adverse effect of antineoplastic and immunosuppressive drugs

Z41.8

Encounter for other procedures for purposes other than remedying health state

Z51.11

Encounter for antineoplastic chemotherapy

We recommend verifying a health plan's coding policies. The Eisai Assistance Program can provide information to patients and healthcare professionals relating to payor-specific policies and can address other questions at: 1-866-61-EISAI (1-866-613-4724).

Current Procedural Terminology (CPT) Drug Administration Code

CPT codes are 5-digit numeric codes established by the American Medical Association (AMA) that describe medical procedures and services. ALOXI® (palonosetron HCI injection) is administered as an IV push injection. The following CPT code may be appropriate to report ALOXI® administration services:

CPT Code

Description

9637511

Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure)

Payors may require physicians to report a different drug administration CPT code when billing for ALOXI®. We recommend verifying a health plan’s coding policies. The Eisai Assistance Program can provide information to patients and healthcare professionals relating to payor-specific policies and can address other questions at: 1-866-61-EISAI or 1-866-613-4724.

References

1. CINV: Report chemotherapy administration as the primary procedure code per the AMA CPT® code book Current Procedural Terminology (CPT), Fourth Edition, Section: Medicine, Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration.

Healthcare Common Procedure Coding System (HCPCS) Level II Code

HCPCS codes are 5-digit alphanumeric codes that are assigned to drugs by the Centers for Medicare and Medicaid Services (CMS). ALOXI® (palonosetron HCI injection) has been assigned the following unique HCPCS codes in the "J" series (known as J codes):

ALOXI® HCPCS Code

Description

J2469

Injection, palonosetron HCl, 25 mcg

When billing for a drug, payors require physicians to indicate on the claim form the quantity of product administered to the patient expressed in the number of units described by the HCPCS code. Because the HCPCS code for ALOXI® is expressed as 25 mcg, the amount of ALOXI® administered to a patient is expressed in multiples of 25 mcg on the claim form.

Vial Size

Number of Units

0.25 mg/5mL (free base) single-use vial

Report 10 units of J2469 for a 0.25 mg dose

0.075 mg/1.5mL (free base) single-use vial

Report 3 units of J2469 for a 0.075 mg dose

We recommend verifying an insurer’s coding policies. The Eisai Assistance Program can provide information to patients and healthcare professionals relating to payor-specific policies and can address other questions at: 1-866-61-EISAI or 1-866-613-4724.

ALOXI® National Drug Codes (NDC)

The National Drug Code is a unique 10-digit, 3-segment numeric identifier assigned to each medication listed under Section 510 of the US Federal Food, Drug, and Cosmetic Act. The NDC number identifies the labeler, product, and trade package size. ALOXI® has two NDC numbers which have been assigned based on the different available package sizes.

ALOXI® Package Size

NDC

0.25 mg (free base) per 5 mL single-use vial individually packaged in a carton

62856-797-01

0.075 mg (free base) per 1.5 mL single-use vial packaged in a carton containing 5 vials

62856-798-01

Products are supplied as single-use sterile, clear, colorless solutions in glass vials. 

Some payors require physicians to report 11-digit NDCs when reporting a drug on a claim form. Converting the 10-digit NDC for ALOXI® to an 11-digit NDC requires the use of a leading zero in the product code section of the NDC (i.e., the middle section):

10-Digit NDC Example

11-Digit NDC Example With Leading Zero

AAAAA-BBB-CC

AAAAA-0BBB-CC

ALOXI® 10-Digit NDC

ALOXI® 11-Digit NDC With Leading Zero

62856-797-01

62856-0797-01

Revenue codes capture facility cost data by department, which the facility uses for cost reporting purposes. Some payors request that providers report revenue codes on claim forms. Hospital outpatient departments typically report revenue code 0636 for ALOXI® (palonosetron HCI injection).

Revenue Code

Description

0250

General pharmacy

0636

Drugs requiring detailed coding

Average Sales Price (ASP) rates are recalculated and released on a quarterly basis by CMS but can be updated more frequently. Please visit the CMS website below for the most up to date information.

Medicare Reimbursement Rate - Physician Office1

Medicare Reimbursement Rate - Hospital Outpatient2

For additional information and assistance with ALOXI®, please contact the Eisai Assistance Program at 1-866-61-EISAI or 1-866-613-4724, Monday through Friday from 8:00 A.M. to 8:00 P.M. (Eastern Time).

References

1. Centers for Medicare & Medicaid Services Website, Medicare, Medicare Part B Drug Pricing Files. Accessed on February 10, 2016 at this address: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/index.html. Rates are subject to change.

2. Centers for Medicare & Medicaid Services Website, Medicare, Hospital Outpatient PPS. Accessed on February 10, 2016 at this address: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html.

Do Your Patients Need Financial Assistance?

Programs run by Eisai and Assistance Foundations are available to manage out-of-pocket costs.

Worried About Chemo-Induced Nausea and Vomiting?

ALOXI® is an anti-nausea medication that may help prevent nausea and vomiting associated with chemotherapy.

Eisai cannot guarantee payment of any claim. Coding, coverage, and reimbursement may vary significantly by payor, plan, patient, and setting of care. Actual coverage and reimbursement decisions are made by individual payors following the receipt of claims. For additional information, customers should consult with their payors for all relevant coding, reimbursement, and coverage requirements. It is the sole responsibility of the provider to select the proper code and ensure the accuracy of all claims used in seeking reimbursement. All services must be medically appropriate and properly supported in the patient medical record

+ EXPAND- COLLAPSE

Indication in Pediatrics

ALOXI® injection 20mcg/kg (max 1.5mg) is indicated in patients ≥ 1 month up to 17 years of age, for the prevention of acute nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemotherapy, including highly emetogenic chemotherapy.

Indication in Adults

ALOXI® injection 0.25 mg is indicated in adults for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic chemotherapy, and the prevention of acute nausea and vomiting associated with initial and repeat courses of highly emetogenic chemotherapy.

Important Safety Information

Contraindications

  • ALOXI® is contraindicated in patients known to have hypersensitivity to the drug or any of its components
  • Warnings and Precautions

  • Hypersensitivity reactions, including anaphylaxis, have been reported with or without known hypersensitivity to other 5-HT3 receptor antagonists
  • Serotonin syndrome has been reported with 5-HT3 receptor antagonists alone, but particularly with the use of serotonergic drugs. Serotonin syndrome can be life threatening. Symptoms may include the following combination of signs and symptoms: mental status changes, autonomic instability, neuromuscular symptoms, seizures, and gastrointestinal symptoms. Patients should be monitored for the emergence of serotonin syndrome, and if symptoms occur, discontinue ALOXI® and initiate supportive treatment. Patients should be informed of the increased risk of serotonin syndrome, especially if ALOXI® is used concomitantly with other serotonergic drugs

     

    For more information about ALOXI®, please see full Prescribing Information.
    You are encouraged to report negative side effects of prescription drugs to the FDA.
    Visit http://www.FDA.gov/medwatch or call 1-800-FDA-1088.

  • This information is intended for use by our healthcare professionals in the United States only. Eisai Inc. recognizes the Internet is a global communications medium; however, laws, regulatory requirements and medical practices for pharmaceutical products vary from country to country. The Prescribing Information included here is not appropriate for use outside the United States. This site contains information about products that may have different product labeling in different countries. This site is published by Eisai Inc. 

    ALOXI® is a registered trademark of Helsinn Healthcare SA, Switzerland, used under license.
    Distributed and marketed by Eisai Inc and Helsinn Therapeutics (U.S.), Inc.
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