Skip to Main Content
Issue Number - Name
0036 - Trastuzumab (Herceptin), Multi-Dose Vial
Review Type
Complex
Claim Type
Physician, Outpatient Hospital, Professional Services (Physician/Non-Physician Practitioner)
Region and State
RAC 1-4
All States
Date Approved
2017-02-01

Description

Coding Review: Documentation will be reviewed to determine if the billed amount of trastuzumab (Herceptin) meets Medicare coverage criteria and applicable coding guidelines.

Affected Codes

  • J9355

Applicable Policy References

  • Social Security Act, Section 1833 (e)
  • CMS Pub. 100-04, Medicare Claims Processing Manual,  Chapter 17, Section 40
  • Herceptin Package Label (manufacturer website)