SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)

A52450

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Source Article ID
N/A
Article ID
A52450
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
01/11/2024
Revision Ending Date
09/30/2024
Retirement Date
N/A

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Article Guidance

Article Text

This article contains billing and coding guidelines that complement the Local Coverage Determination (LCD) Drugs and Biologicals, Coverage of, for Label and Off-Label Uses.

Abstract:

Paclitaxel is a natural product with antitumor (antineoplastic) activity obtained via a semi-synthetic process from Taxus baccata. Paclictaxel is administered as an intravenous agent and inhibits the replication of cells by interfering with mitosis (cellular division).

Documentation Requirements:

For any claims submitted for albumin-bound paclitaxel, documentation should be included in the patient's medical record showing prior therapy included an anthracycline unless clinically contraindicated.

When modifier –JW is used to report that a portion of the drug is discarded, the medical record must clearly show the amount administered and the amount wasted. Effective July 1, 2023 (CR 13056) JZ Modifier is required on all claims that bill for drugs separately payable under Medicare Part B when there are no discarded amounts from single-dose containers or single-use packages.

 Utilization:

Dose and frequency should be in accordance with the FDA label or recognized compendia (for off-label uses). When services are performed in excess of established parameters, they may be subject to review for medical necessity.

Coding Information:

When billing for metastatic (secondary) disease, only use the code for the primary malignancy if still present, and only use the related “personal history of” Z code if not. 

FDA and Compendia Review:

American Society of Health-System Pharmacists, Inc. AHFS Drug Information®. Bethesda, MD: 2007.

Clinical Pharmacology Web site. http://www.clinicalpharmacology.com/. Accessed 06/06/2023.

Lexi-Drugs Web site. http://online.lexi.com. Accessed 06/06/2023.

Micromedex DrugDex®. http://www.thomsonhc.com/home/dispatch. Accessed 06/06/2023.

National Comprehensive Cancer Network Web site. http://www.nccn.org/index.asp. Accessed 06/02/2023.

U.S. Food and Drug Administration label Drugs@FDA Web site. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/. Accessed 02/01/2008.

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Coding Information

Bill Type Codes

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(231 Codes)
Group 1 Paragraph

The following ICD-10-CM codes are payable for albumin-bound paclitaxel only. ICD-10-CM codes T45.0X5A-T45.0X5S, T45.1X5A-T45.1X5S, T47.7X5A-T47.7X5S or T50.995A-T50.995S should only be added to claims to indicate that the patient experienced hypersensitivity reactions after receiving paclitaxel or docetaxel despite premedication or for patients in whom standard hypersensitivity premedications are contraindicated.

Group 1 Codes
Code Description
C16.0 Malignant neoplasm of cardia
C16.1 Malignant neoplasm of fundus of stomach
C16.2 Malignant neoplasm of body of stomach
C16.3 Malignant neoplasm of pyloric antrum
C16.4 Malignant neoplasm of pylorus
C16.5 Malignant neoplasm of lesser curvature of stomach, unspecified
C16.6 Malignant neoplasm of greater curvature of stomach, unspecified
C16.8 Malignant neoplasm of overlapping sites of stomach
C17.0 Malignant neoplasm of duodenum
C17.1 Malignant neoplasm of jejunum
C17.2 Malignant neoplasm of ileum
C17.3 Meckel's diverticulum, malignant
C17.8 Malignant neoplasm of overlapping sites of small intestine
C21.0 Malignant neoplasm of anus, unspecified
C21.1 Malignant neoplasm of anal canal
C22.1 Intrahepatic bile duct carcinoma
C23 Malignant neoplasm of gallbladder
C24.0 Malignant neoplasm of extrahepatic bile duct
C24.1 Malignant neoplasm of ampulla of Vater
C24.8 Malignant neoplasm of overlapping sites of biliary tract
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C25.9 Malignant neoplasm of pancreas, unspecified
C33 Malignant neoplasm of trachea
C34.00 - C34.92 Malignant neoplasm of unspecified main bronchus - Malignant neoplasm of unspecified part of left bronchus or lung
C43.0 - C43.9 Malignant melanoma of lip - Malignant melanoma of skin, unspecified
C45.1 Mesothelioma of peritoneum
C46.0 - C46.4 Kaposi's sarcoma of skin - Kaposi's sarcoma of gastrointestinal sites
C46.51 Kaposi's sarcoma of right lung
C46.52 Kaposi's sarcoma of left lung
C46.7 Kaposi's sarcoma of other sites
C48.1 Malignant neoplasm of specified parts of peritoneum
C48.2 Malignant neoplasm of peritoneum, unspecified
C48.8 Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
C50.011 - C50.929 Malignant neoplasm of nipple and areola, right female breast - Malignant neoplasm of unspecified site of unspecified male breast
C53.0 Malignant neoplasm of endocervix
C53.1 Malignant neoplasm of exocervix
C53.8 Malignant neoplasm of overlapping sites of cervix uteri
C54.0 - C54.3 Malignant neoplasm of isthmus uteri - Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C56.9 Malignant neoplasm of unspecified ovary
C57.00 - C57.22 Malignant neoplasm of unspecified fallopian tube - Malignant neoplasm of left round ligament
C57.3 Malignant neoplasm of parametrium
C57.4 Malignant neoplasm of uterine adnexa, unspecified
C57.7 Malignant neoplasm of other specified female genital organs
C57.8 Malignant neoplasm of overlapping sites of female genital organs
C61 Malignant neoplasm of prostate
C65.1 Malignant neoplasm of right renal pelvis
C65.2 Malignant neoplasm of left renal pelvis
C65.9 Malignant neoplasm of unspecified renal pelvis
C66.1 Malignant neoplasm of right ureter
C66.2 Malignant neoplasm of left ureter
C66.9 Malignant neoplasm of unspecified ureter
C67.0 - C67.9 Malignant neoplasm of trigone of bladder - Malignant neoplasm of bladder, unspecified
C68.0 Malignant neoplasm of urethra
C69.31 Malignant neoplasm of right choroid
C69.32 Malignant neoplasm of left choroid
C69.41 Malignant neoplasm of right ciliary body
C69.42 Malignant neoplasm of left ciliary body
C69.61 Malignant neoplasm of right orbit
C69.62 Malignant neoplasm of left orbit
C76.0 Malignant neoplasm of head, face and neck
D03.0 - D03.9 Melanoma in situ of lip - Melanoma in situ, unspecified
D09.0 Carcinoma in situ of bladder
D37.1 Neoplasm of uncertain behavior of stomach
T45.0X5A - T45.0X5S Adverse effect of antiallergic and antiemetic drugs, initial encounter - Adverse effect of antiallergic and antiemetic drugs, sequela
T45.1X5A - T45.1X5S Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter - Adverse effect of antineoplastic and immunosuppressive drugs, sequela
T47.7X5A - T47.7X5S Adverse effect of emetics, initial encounter - Adverse effect of emetics, sequela
T50.995A - T50.995S Adverse effect of other drugs, medicaments and biological substances, initial encounter - Adverse effect of other drugs, medicaments and biological substances, sequela
Z85.068 Personal history of other malignant neoplasm of small intestine
Z85.07 Personal history of malignant neoplasm of pancreas
Z85.09 Personal history of malignant neoplasm of other digestive organs
Z85.118 Personal history of other malignant neoplasm of bronchus and lung
Z85.3 Personal history of malignant neoplasm of breast
Z85.42 Personal history of malignant neoplasm of other parts of uterus
Z85.43 Personal history of malignant neoplasm of ovary
Z85.51 Personal history of malignant neoplasm of bladder
Z85.59 Personal history of malignant neoplasm of other urinary tract organ
Z85.820 Personal history of malignant melanoma of skin

Group 2

(645 Codes)
Group 2 Paragraph

The following ICD-10-CM codes are payable for paclitaxel only.

Group 2 Codes
Code Description
C00.0 Malignant neoplasm of external upper lip
C00.1 Malignant neoplasm of external lower lip
C00.2 Malignant neoplasm of external lip, unspecified
C00.3 Malignant neoplasm of upper lip, inner aspect
C00.4 Malignant neoplasm of lower lip, inner aspect
C00.5 Malignant neoplasm of lip, unspecified, inner aspect
C00.6 Malignant neoplasm of commissure of lip, unspecified
C00.8 Malignant neoplasm of overlapping sites of lip
C00.9 Malignant neoplasm of lip, unspecified
C01 Malignant neoplasm of base of tongue
C02.0 Malignant neoplasm of dorsal surface of tongue
C02.1 Malignant neoplasm of border of tongue
C02.2 Malignant neoplasm of ventral surface of tongue
C02.3 Malignant neoplasm of anterior two-thirds of tongue, part unspecified
C02.4 Malignant neoplasm of lingual tonsil
C02.8 Malignant neoplasm of overlapping sites of tongue
C02.9 Malignant neoplasm of tongue, unspecified
C03.0 Malignant neoplasm of upper gum
C03.1 Malignant neoplasm of lower gum
C03.9 Malignant neoplasm of gum, unspecified
C04.0 Malignant neoplasm of anterior floor of mouth
C04.1 Malignant neoplasm of lateral floor of mouth
C04.8 Malignant neoplasm of overlapping sites of floor of mouth
C04.9 Malignant neoplasm of floor of mouth, unspecified
C05.0 Malignant neoplasm of hard palate
C05.1 Malignant neoplasm of soft palate
C05.2 Malignant neoplasm of uvula
C05.8 Malignant neoplasm of overlapping sites of palate
C05.9 Malignant neoplasm of palate, unspecified
C06.0 Malignant neoplasm of cheek mucosa
C06.1 Malignant neoplasm of vestibule of mouth
C06.2 Malignant neoplasm of retromolar area
C06.80 Malignant neoplasm of overlapping sites of unspecified parts of mouth
C06.89 Malignant neoplasm of overlapping sites of other parts of mouth
C06.9 Malignant neoplasm of mouth, unspecified
C07 Malignant neoplasm of parotid gland
C08.0 Malignant neoplasm of submandibular gland
C08.1 Malignant neoplasm of sublingual gland
C08.9 Malignant neoplasm of major salivary gland, unspecified
C09.0 Malignant neoplasm of tonsillar fossa
C09.1 Malignant neoplasm of tonsillar pillar (anterior) (posterior)
C09.8 Malignant neoplasm of overlapping sites of tonsil
C09.9 Malignant neoplasm of tonsil, unspecified
C10.0 Malignant neoplasm of vallecula
C10.1 Malignant neoplasm of anterior surface of epiglottis
C10.2 Malignant neoplasm of lateral wall of oropharynx
C10.3 Malignant neoplasm of posterior wall of oropharynx
C10.4 Malignant neoplasm of branchial cleft
C10.8 Malignant neoplasm of overlapping sites of oropharynx
C10.9 Malignant neoplasm of oropharynx, unspecified
C11.0 Malignant neoplasm of superior wall of nasopharynx
C11.1 Malignant neoplasm of posterior wall of nasopharynx
C11.2 Malignant neoplasm of lateral wall of nasopharynx
C11.3 Malignant neoplasm of anterior wall of nasopharynx
C11.8 Malignant neoplasm of overlapping sites of nasopharynx
C11.9 Malignant neoplasm of nasopharynx, unspecified
C12 Malignant neoplasm of pyriform sinus
C13.0 Malignant neoplasm of postcricoid region
C13.1 Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect
C13.2 Malignant neoplasm of posterior wall of hypopharynx
C13.8 Malignant neoplasm of overlapping sites of hypopharynx
C13.9 Malignant neoplasm of hypopharynx, unspecified
C14.0 Malignant neoplasm of pharynx, unspecified
C14.2 Malignant neoplasm of Waldeyer's ring
C14.8 Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx
C15.3 Malignant neoplasm of upper third of esophagus
C15.4 Malignant neoplasm of middle third of esophagus
C15.5 Malignant neoplasm of lower third of esophagus
C15.8 Malignant neoplasm of overlapping sites of esophagus
C15.9 Malignant neoplasm of esophagus, unspecified
C16.0 Malignant neoplasm of cardia
C16.1 Malignant neoplasm of fundus of stomach
C16.2 Malignant neoplasm of body of stomach
C16.3 Malignant neoplasm of pyloric antrum
C16.4 Malignant neoplasm of pylorus
C16.5 Malignant neoplasm of lesser curvature of stomach, unspecified
C16.6 Malignant neoplasm of greater curvature of stomach, unspecified
C16.8 Malignant neoplasm of overlapping sites of stomach
C16.9 Malignant neoplasm of stomach, unspecified
C17.0 Malignant neoplasm of duodenum
C17.1 Malignant neoplasm of jejunum
C17.2 Malignant neoplasm of ileum
C17.3 Meckel's diverticulum, malignant
C17.8 Malignant neoplasm of overlapping sites of small intestine
C21.0 Malignant neoplasm of anus, unspecified
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C22.3 Angiosarcoma of liver
C24.1 Malignant neoplasm of ampulla of Vater
C30.0 Malignant neoplasm of nasal cavity
C30.1 Malignant neoplasm of middle ear
C31.0 Malignant neoplasm of maxillary sinus
C31.1 Malignant neoplasm of ethmoidal sinus
C31.2 Malignant neoplasm of frontal sinus
C31.3 Malignant neoplasm of sphenoid sinus
C31.8 Malignant neoplasm of overlapping sites of accessory sinuses
C31.9 Malignant neoplasm of accessory sinus, unspecified
C32.0 Malignant neoplasm of glottis
C32.1 Malignant neoplasm of supraglottis
C32.2 Malignant neoplasm of subglottis
C32.3 Malignant neoplasm of laryngeal cartilage
C32.8 Malignant neoplasm of overlapping sites of larynx
C32.9 Malignant neoplasm of larynx, unspecified
C33 Malignant neoplasm of trachea
C34.00 - C34.92 Malignant neoplasm of unspecified main bronchus - Malignant neoplasm of unspecified part of left bronchus or lung
C37 Malignant neoplasm of thymus
C43.0 - C43.9 Malignant melanoma of lip - Malignant melanoma of skin, unspecified
C44.00 - C44.1292 Unspecified malignant neoplasm of skin of lip - Squamous cell carcinoma of skin of left lower eyelid, including canthus
C44.1321 - C44.99 Sebaceous cell carcinoma of skin of right upper eyelid, including canthus - Other specified malignant neoplasm of skin, unspecified
C45.1 Mesothelioma of peritoneum
C45.9 Mesothelioma, unspecified
C46.0 Kaposi's sarcoma of skin
C46.1 Kaposi's sarcoma of soft tissue
C46.2 Kaposi's sarcoma of palate
C46.3 Kaposi's sarcoma of lymph nodes
C46.4 Kaposi's sarcoma of gastrointestinal sites
C46.50 Kaposi's sarcoma of unspecified lung
C46.51 Kaposi's sarcoma of right lung
C46.52 Kaposi's sarcoma of left lung
C46.7 Kaposi's sarcoma of other sites
C46.9 Kaposi's sarcoma, unspecified
C47.0 - C47.9 Malignant neoplasm of peripheral nerves of head, face and neck - Malignant neoplasm of peripheral nerves and autonomic nervous system, unspecified
C48.0 Malignant neoplasm of retroperitoneum
C48.1 Malignant neoplasm of specified parts of peritoneum
C48.2 Malignant neoplasm of peritoneum, unspecified
C48.8 Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
C49.0 - C49.9 Malignant neoplasm of connective and soft tissue of head, face and neck - Malignant neoplasm of connective and soft tissue, unspecified
C50.011 - C50.929 Malignant neoplasm of nipple and areola, right female breast - Malignant neoplasm of unspecified site of unspecified male breast
C51.0 - C51.2 Malignant neoplasm of labium majus - Malignant neoplasm of clitoris
C51.8 Malignant neoplasm of overlapping sites of vulva
C51.9 Malignant neoplasm of vulva, unspecified
C53.0 Malignant neoplasm of endocervix
C53.1 Malignant neoplasm of exocervix
C53.8 Malignant neoplasm of overlapping sites of cervix uteri
C53.9 Malignant neoplasm of cervix uteri, unspecified
C54.0 Malignant neoplasm of isthmus uteri
C54.1 Malignant neoplasm of endometrium
C54.2 Malignant neoplasm of myometrium
C54.3 Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri
C54.9 Malignant neoplasm of corpus uteri, unspecified
C55 Malignant neoplasm of uterus, part unspecified
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C56.9 Malignant neoplasm of unspecified ovary
C57.00 Malignant neoplasm of unspecified fallopian tube
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
C57.10 Malignant neoplasm of unspecified broad ligament
C57.11 Malignant neoplasm of right broad ligament
C57.12 Malignant neoplasm of left broad ligament
C57.20 Malignant neoplasm of unspecified round ligament
C57.21 Malignant neoplasm of right round ligament
C57.22 Malignant neoplasm of left round ligament
C57.3 Malignant neoplasm of parametrium
C57.4 Malignant neoplasm of uterine adnexa, unspecified
C57.7 Malignant neoplasm of other specified female genital organs
C57.8 Malignant neoplasm of overlapping sites of female genital organs
C60.0 Malignant neoplasm of prepuce
C60.1 Malignant neoplasm of glans penis
C60.2 Malignant neoplasm of body of penis
C60.8 Malignant neoplasm of overlapping sites of penis
C60.9 Malignant neoplasm of penis, unspecified
C61 Malignant neoplasm of prostate
C62.00 - C62.92 Malignant neoplasm of unspecified undescended testis - Malignant neoplasm of left testis, unspecified whether descended or undescended
C63.7 Malignant neoplasm of other specified male genital organs
C63.8 Malignant neoplasm of overlapping sites of male genital organs
C63.9 Malignant neoplasm of male genital organ, unspecified
C64.1 Malignant neoplasm of right kidney, except renal pelvis
C64.2 Malignant neoplasm of left kidney, except renal pelvis
C64.9 Malignant neoplasm of unspecified kidney, except renal pelvis
C65.1 Malignant neoplasm of right renal pelvis
C65.2 Malignant neoplasm of left renal pelvis
C65.9 Malignant neoplasm of unspecified renal pelvis
C66.1 Malignant neoplasm of right ureter
C66.2 Malignant neoplasm of left ureter
C66.9 Malignant neoplasm of unspecified ureter
C67.0 Malignant neoplasm of trigone of bladder
C67.1 Malignant neoplasm of dome of bladder
C67.2 Malignant neoplasm of lateral wall of bladder
C67.3 Malignant neoplasm of anterior wall of bladder
C67.4 Malignant neoplasm of posterior wall of bladder
C67.5 Malignant neoplasm of bladder neck
C67.6 Malignant neoplasm of ureteric orifice
C67.7 Malignant neoplasm of urachus
C67.8 Malignant neoplasm of overlapping sites of bladder
C67.9 Malignant neoplasm of bladder, unspecified
C68.0 Malignant neoplasm of urethra
C69.31 Malignant neoplasm of right choroid
C69.32 Malignant neoplasm of left choroid
C69.41 Malignant neoplasm of right ciliary body
C69.42 Malignant neoplasm of left ciliary body
C69.61 Malignant neoplasm of right orbit
C69.62 Malignant neoplasm of left orbit
C71.0 Malignant neoplasm of cerebrum, except lobes and ventricles
C71.1 Malignant neoplasm of frontal lobe
C71.2 Malignant neoplasm of temporal lobe
C71.3 Malignant neoplasm of parietal lobe
C71.4 Malignant neoplasm of occipital lobe
C71.5 Malignant neoplasm of cerebral ventricle
C71.6 Malignant neoplasm of cerebellum
C71.7 Malignant neoplasm of brain stem
C71.8 Malignant neoplasm of overlapping sites of brain
C71.9 Malignant neoplasm of brain, unspecified
C73 Malignant neoplasm of thyroid gland
C7A.1 Malignant poorly differentiated neuroendocrine tumors
C7A.8 Other malignant neuroendocrine tumors
C76.0 Malignant neoplasm of head, face and neck
C80.0 Disseminated malignant neoplasm, unspecified
C80.1 Malignant (primary) neoplasm, unspecified
C82.50 Diffuse follicle center lymphoma, unspecified site
C82.51 Diffuse follicle center lymphoma, lymph nodes of head, face, and neck
C82.52 Diffuse follicle center lymphoma, intrathoracic lymph nodes
C82.53 Diffuse follicle center lymphoma, intra-abdominal lymph nodes
C82.54 Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb
C82.55 Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.56 Diffuse follicle center lymphoma, intrapelvic lymph nodes
C82.57 Diffuse follicle center lymphoma, spleen
C82.58 Diffuse follicle center lymphoma, lymph nodes of multiple sites
C82.59 Diffuse follicle center lymphoma, extranodal and solid organ sites
C83.00 Small cell B-cell lymphoma, unspecified site
C83.01 Small cell B-cell lymphoma, lymph nodes of head, face, and neck
C83.02 Small cell B-cell lymphoma, intrathoracic lymph nodes
C83.03 Small cell B-cell lymphoma, intra-abdominal lymph nodes
C83.04 Small cell B-cell lymphoma, lymph nodes of axilla and upper limb
C83.05 Small cell B-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.06 Small cell B-cell lymphoma, intrapelvic lymph nodes
C83.07 Small cell B-cell lymphoma, spleen
C83.08 Small cell B-cell lymphoma, lymph nodes of multiple sites
C83.09 Small cell B-cell lymphoma, extranodal and solid organ sites
C83.80 Other non-follicular lymphoma, unspecified site
C83.81 Other non-follicular lymphoma, lymph nodes of head, face, and neck
C83.82 Other non-follicular lymphoma, intrathoracic lymph nodes
C83.83 Other non-follicular lymphoma, intra-abdominal lymph nodes
C83.84 Other non-follicular lymphoma, lymph nodes of axilla and upper limb
C83.85 Other non-follicular lymphoma, lymph nodes of inguinal region and lower limb
C83.86 Other non-follicular lymphoma, intrapelvic lymph nodes
C83.87 Other non-follicular lymphoma, spleen
C83.88 Other non-follicular lymphoma, lymph nodes of multiple sites
C83.89 Other non-follicular lymphoma, extranodal and solid organ sites
C83.90 Non-follicular (diffuse) lymphoma, unspecified, unspecified site
C83.91 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of head, face, and neck
C83.92 Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes
C83.94 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of axilla and upper limb
C83.95 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C83.96 Non-follicular (diffuse) lymphoma, unspecified, intrapelvic lymph nodes
C83.97 Non-follicular (diffuse) lymphoma, unspecified, spleen
C83.98 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of multiple sites
C83.99 Non-follicular (diffuse) lymphoma, unspecified, extranodal and solid organ sites
C84.40 Peripheral T-cell lymphoma, not elsewhere classified, unspecified site
C84.41 Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of head, face, and neck
C84.42 Peripheral T-cell lymphoma, not elsewhere classified, intrathoracic lymph nodes
C84.43 Peripheral T-cell lymphoma, not elsewhere classified, intra-abdominal lymph nodes
C84.44 Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of axilla and upper limb
C84.45 Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of inguinal region and lower limb
C84.46 Peripheral T-cell lymphoma, not elsewhere classified, intrapelvic lymph nodes
C84.47 Peripheral T-cell lymphoma, not elsewhere classified, spleen
C84.48 Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of multiple sites
C84.49 Peripheral T-cell lymphoma, not elsewhere classified, extranodal and solid organ sites
C84.A0 Cutaneous T-cell lymphoma, unspecified, unspecified site
C84.A1 Cutaneous T-cell lymphoma, unspecified lymph nodes of head, face, and neck
C84.A2 Cutaneous T-cell lymphoma, unspecified, intrathoracic lymph nodes
C84.A3 Cutaneous T-cell lymphoma, unspecified, intra-abdominal lymph nodes
C84.A4 Cutaneous T-cell lymphoma, unspecified, lymph nodes of axilla and upper limb
C84.A5 Cutaneous T-cell lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C84.A6 Cutaneous T-cell lymphoma, unspecified, intrapelvic lymph nodes
C84.A7 Cutaneous T-cell lymphoma, unspecified, spleen
C84.A8 Cutaneous T-cell lymphoma, unspecified, lymph nodes of multiple sites
C84.A9 Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ sites
C84.Z0 Other mature T/NK-cell lymphomas, unspecified site
C84.Z1 Other mature T/NK-cell lymphomas, lymph nodes of head, face, and neck
C84.Z2 Other mature T/NK-cell lymphomas, intrathoracic lymph nodes
C84.Z3 Other mature T/NK-cell lymphomas, intra-abdominal lymph nodes
C84.Z4 Other mature T/NK-cell lymphomas, lymph nodes of axilla and upper limb
C84.Z5 Other mature T/NK-cell lymphomas, lymph nodes of inguinal region and lower limb
C84.Z6 Other mature T/NK-cell lymphomas, intrapelvic lymph nodes
C84.Z7 Other mature T/NK-cell lymphomas, spleen
C84.Z8 Other mature T/NK-cell lymphomas, lymph nodes of multiple sites
C84.Z9 Other mature T/NK-cell lymphomas, extranodal and solid organ sites
C84.90 Mature T/NK-cell lymphomas, unspecified, unspecified site
C84.91 Mature T/NK-cell lymphomas, unspecified, lymph nodes of head, face, and neck
C84.92 Mature T/NK-cell lymphomas, unspecified, intrathoracic lymph nodes
C84.93 Mature T/NK-cell lymphomas, unspecified, intra-abdominal lymph nodes
C84.94 Mature T/NK-cell lymphomas, unspecified, lymph nodes of axilla and upper limb
C84.95 Mature T/NK-cell lymphomas, unspecified, lymph nodes of inguinal region and lower limb
C84.96 Mature T/NK-cell lymphomas, unspecified, intrapelvic lymph nodes
C84.97 Mature T/NK-cell lymphomas, unspecified, spleen
C84.99 Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites
C85.10 - C85.99 Unspecified B-cell lymphoma, unspecified site - Non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites
C86.0 Extranodal NK/T-cell lymphoma, nasal type
C86.1 Hepatosplenic T-cell lymphoma
C86.2 Enteropathy-type (intestinal) T-cell lymphoma
C86.3 Subcutaneous panniculitis-like T-cell lymphoma
C86.4 Blastic NK-cell lymphoma
C86.5 Angioimmunoblastic T-cell lymphoma
C86.6 Primary cutaneous CD30-positive T-cell proliferations
C90.00 Multiple myeloma not having achieved remission
C90.01 Multiple myeloma in remission
C90.02 Multiple myeloma in relapse
C96.4 Sarcoma of dendritic cells (accessory cells)
C96.Z Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
C96.9 Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified
D03.0 - D03.9 Melanoma in situ of lip - Melanoma in situ, unspecified
D09.0 Carcinoma in situ of bladder
D15.0 Benign neoplasm of thymus
D37.01 Neoplasm of uncertain behavior of lip
D37.02 Neoplasm of uncertain behavior of tongue
D37.04 Neoplasm of uncertain behavior of the minor salivary glands
D37.05 Neoplasm of uncertain behavior of pharynx
D37.09 Neoplasm of uncertain behavior of other specified sites of the oral cavity
D37.1 Neoplasm of uncertain behavior of stomach
D37.2 Neoplasm of uncertain behavior of small intestine
D37.3 Neoplasm of uncertain behavior of appendix
D37.4 Neoplasm of uncertain behavior of colon
D37.5 Neoplasm of uncertain behavior of rectum
D37.8 Neoplasm of uncertain behavior of other specified digestive organs
D37.9 Neoplasm of uncertain behavior of digestive organ, unspecified
D38.0 Neoplasm of uncertain behavior of larynx
D38.4 Neoplasm of uncertain behavior of thymus
D38.5 Neoplasm of uncertain behavior of other respiratory organs
D38.6 Neoplasm of uncertain behavior of respiratory organ, unspecified
D49.0 Neoplasm of unspecified behavior of digestive system
D49.1 Neoplasm of unspecified behavior of respiratory system
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
D49.6 Neoplasm of unspecified behavior of brain
D49.89 Neoplasm of unspecified behavior of other specified sites
D49.9 Neoplasm of unspecified behavior of unspecified site
O09.891 - O09.893 Supervision of other high risk pregnancies, first trimester - Supervision of other high risk pregnancies, third trimester
O09.899 Supervision of other high risk pregnancies, unspecified trimester
O09.90 - O09.93 Supervision of high risk pregnancy, unspecified, unspecified trimester - Supervision of high risk pregnancy, unspecified, third trimester
Z80.49 Family history of malignant neoplasm of other genital organs
Z85.00 Personal history of malignant neoplasm of unspecified digestive organ
Z85.01 Personal history of malignant neoplasm of esophagus
Z85.028 Personal history of other malignant neoplasm of stomach
Z85.068 Personal history of other malignant neoplasm of small intestine
Z85.118 Personal history of other malignant neoplasm of bronchus and lung
Z85.12 Personal history of malignant neoplasm of trachea
Z85.21 Personal history of malignant neoplasm of larynx
Z85.22 Personal history of malignant neoplasm of nasal cavities, middle ear, and accessory sinuses
Z85.238 Personal history of other malignant neoplasm of thymus
Z85.29 Personal history of malignant neoplasm of other respiratory and intrathoracic organs
Z85.3 Personal history of malignant neoplasm of breast
Z85.42 Personal history of malignant neoplasm of other parts of uterus
Z85.43 Personal history of malignant neoplasm of ovary
Z85.47 Personal history of malignant neoplasm of testis
Z85.49 Personal history of malignant neoplasm of other male genital organs
Z85.51 Personal history of malignant neoplasm of bladder
Z85.59 Personal history of malignant neoplasm of other urinary tract organ
Z85.810 Personal history of malignant neoplasm of tongue
Z85.818 Personal history of malignant neoplasm of other sites of lip, oral cavity, and pharynx
Z85.819 Personal history of malignant neoplasm of unspecified site of lip, oral cavity, and pharynx
Z85.820 Personal history of malignant melanoma of skin
Z94.81 Bone marrow transplant status
Z94.89 Other transplanted organ and tissue status
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/11/2024 R22

Information regarding the use of the JW and JZ modifier has been added to the Documentation Requirements section. Based on Transmittal 12067 (CR 13056) - New Claims Modifier Requirement for Drugs and Biologicals from a Single-Dose Container or Single-Use Package, information on use of the JZ modifier has been added to the Documentation Requirements section of the article.

01/01/2024 R21

Per Transmittal 12233 (CR 13356) - Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - January 2024 Update, HCPCS code J9258 has been added.

07/01/2023 R20

Per Transmittal 12072 (CR 13208) - Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2023 Update, HCPCS Code J9259 has been added. Based on compendia review, ICD-10 codes Z85.09 and Z85.42 have been added to the Group 1 codes for albumin-bound paclitaxel and ICD-10 code Z85.42 has been added for paclitaxel effective for dates of service on or after 07/01/2023.

04/01/2023 R19

Based on compendia review, ICD-10 codes C53.0, C53.1 and C53.8 have been added to the Group 1 ICD-10 code list for albumin-bound paclitaxel and ICD-10 code D38.4 has been added to the Group 2 ICD-10 code list for paclitaxel effective for dates of service on or after 04/01/2023.

10/01/2022 R18

Based on the annual ICD-10 code update, the descriptors for ICD-10 codes C84.40, C84.41, C84.42, C84.43, C84.44, C84.45, C84.46, C84.47, C84.48, C84.49 has been revised in the Group 2 list.

07/01/2022 R17

Based on compendia review, ICD-10 code Z85.068 has been added to the Group 1 list for albumin-bound paclitaxel and ICD-10 codes Z85.068, Z94.81 and Z94.89 have been added to the Group 2 list for paclitaxel effective for dates of service on or after 07/01/2022.

10/01/2021 R16

Based on the annual ICD-10 code update, ICD-10 code C56.3 has been added to Group 1 and Group 2.

08/01/2021 R15

Based on compendia review, ICD-10 code C21.2 has been added to the Group 2 ICD-10 code list for paclitaxel effective for dates of service on or after 08/01/2021.

05/01/2021 R14

Based on compendia review, ICD-10 codes C23 and C24.1 have been added to the Group 1 list for albumin-bound paclitaxel and ICD-10 code C24.1 has been added to the Group 2 list for paclitaxel effective for dates of service on or after 05/01/2021.

10/01/2020 R13

Based on compendia review, ICD-10-CM code C22.3 has been added to Group 2 for paclitaxel effective for dates of service on or after 10/01/2020.

08/01/2020 R12

Based on compendia review, ICD-10-CM code Z85.49 has been added to Group 2 for paclitaxel effective for dates of service on or after 08/01/2020.

01/01/2020 R11

Based on compendia review, ICD-10-CM codes C17.0, C17.1, C17.2, C17.3 and C17.8 have been added to Groups 1 and 2 for albumin-bound paclitaxel and paclitaxel effective for dates of service on or after 01/01/2020.

11/07/2019 R10

This article was converted to the new Billing and Coding Article format. The Article Text section has been revised to remove the indications which can be found on the FDA Web site and in the approved compendia. The “Sources of Information” has been revised to “FDA and Compendia Review.” Sources of information other than the FDA and compendia have been moved to a PDF file attached to LCD L33394. The Bill type codes have been removed from this article. Guidance on these codes is available in the Bill type code section.

08/01/2019 R9

Based on compendia review, an indication for gastric cancer, refractory to first line fluoropyrimidine-containing chemotherapy has been added for albumin-bound paclitaxel. ICD-10-CM codes C16.0, C16.1, C16.2, C16.3, C16.4, C16.5, C16.6, C16.8 and D37.1 have been added effective for dates of service on or after 08/01/2019. An indication for cutaneous melanoma has been added for paclitaxel.

05/01/2019 R8

Based on compendia review, an indication for hepatobiliary cancers – intrahepatic and extrahepatic cholangiocarcinomas has been added for albumin-bound paclitaxel. ICD-10-CM codes C22.1, C24.0 and C24.8 have been added effective for dates of service on or after 05/01/2019.

10/01/2018 R7

Article revised for annual ICD-10-CM code updates. ICD-10-CM codes C43.11 and C43.12 have been deleted and replaced with C43.111, C43.112, C43.121 and C43.122 in code range C43.0 - C43.9 in Groups 1 and 2 for albumin-bound paclitaxel and paclitaxel. ICD-10-CM codes D03.11 and D03.12 have been deleted and replaced with ICD-10-CM codes D03.111, D03.112, D03.121 and D03.122 in code range D03.0-D03.9 in Groups 1 and 2 for albumin-bound paclitaxel and paclitaxel. ICD-10-CM codes C44.102. C44.109, C44.112, C44.119, C44.122, C44.129, C44.192 and C44.199 have been deleted and replaced with ICD-10-CM codes C44.1021 C44.1022, C44.1091, C44.1092, C44.1121, C44.1122, C44.1191, C44.1192, C44.1221, C44.1222, C44.1291 and C44.1292 in code range C44.00-C44.1292 in Group 2 for paclitaxel and ICD-10-CM codes C44.1321, C44.1322, C44.1391, C44.1392, C44.1921, C44.1922, C44.1991 and C44.1992 have been added to code range C44.1321 – C44.99 in Group 2 for paclitaxel.

05/03/2018 R6

Uveal melanoma has been added to the “Indications” for paclitaxel and albumin-bound paclitaxel. ICD-10-CM codes C69.31, C69.32, C69.41, C69.42, C69.61 and C69.62 have been added to the Group 1 and Group 2 code lists for paclitaxel and albumin-bound paclitaxel effective for dates of service on or after 05/03/2018.

03/01/2018 R5

The indications for paclitaxel have been updated to add anal carcinoma - used in combination with carboplatin with or without radiation for metastatic disease. ICD-10-CM codes C21.8 and Z85.820 have been added to the Group 2 code list for paclitaxel effective for dates of service on or after 03/01/2018. ICD-10-CM codes C49.A0, C49.A1, C49.A2, C49.A3, C49.A4, C49.A5 and C49.A9 are being removed from the Group 2 codes for paclitaxel as they were added in error.

The indications for albumin-bound paclitaxel have been updated to add: 

    AIDS-related Kaposi sarcoma - subsequent systemic therapy given with antiretroviral therapy (ART) for relapsed/refractory advanced, cutaneous, oral, visceral, or nodal disease that has progressed on or not responded to first-line systemic therapy, and progressed on alternate first-line systemic therapy; and 
    Uterine neoplasms - endometrial carcinoma 

ICD-10-CM codes C46.0 - C46.4, C46.51, C46.52, C46.7, C54.0 – C54.3, C54.8, C57.7 and C57.8 have been added to the Group 1 code list for albumin-bound paclitaxel effective for dates of service on or after 03/01/2018.

The coding information for metastatic malignancy has been revised.

10/01/2016 R4 Based on the annual ICD-10-CM code update, ICD-10-CM codes C49.A0, C49.A1, C49.A2, C49.A3, C49.A4, C49.A5 and C49.A9 have been added to the Group 2 Codes for paclitaxel.
09/01/2016 R3 The indications for paclitaxel have been revised to add - Breast cancer - including during pregnancy, Bladder cancer – including urothelial cell carcinoma of the bladder, primary carcinoma of the urethra, upper GU tract tumors and urothelial carcinoma of the prostate. An indication for vulvar cancer has been added. The following ICD-10-CM codes have been added to Group 2 for paclitaxel: C51.0-C51.2, C51.8, C51.9, C57.7, C57.8, C68.0, O09.891-O09.893, O09.899, O09.90-O09.93 and Z85.59 effective for dates of service on or after 09/01/2016. The following indications have been added for paclitaxel albumin-bound - Bladder cancer – including primary carcinoma of the urethra, upper GU tract tumors and urothelial carcinoma of the prostate. The following ICD-10-CM codes have been added to the Group 1 codes for albumin-bound paclitaxel: C61, C65.1, C65.2, C65.9, C66.1, C66.2, C66.9, C67.0-C67.9, C68.0, D09.0, Z85.07, Z85.51, and Z85.59 effective for dates of service on or after 09/01/2016. The first paragraph in the "Indications" section of the article has been revised to include Lexi-Drug compendium. Lexi-Drug Web site has been added to the “Sources of Information” section of the article.
10/01/2015 R2 ICD-10-CM codes C34.00, C34.10, C34.30, C34.80, C43.0 – C43.8, C50.019, C50.119, C50.129, C50.219, C50.319, C50.329, C50.419, C50.429, C50.519, C50.529, C50.619, C50.629, C50.819, C50.829, C50,911, C50,912, C50.919, C50.921, C50.922, C50.929,C56.9, C57.00, C57.10, C57.20, D03.0, D03.10, D03.11, D03.12, D03.20, D03.21, D03.22, D03.39, D03.4, D03.51, D03.52, D03.59, D03.60, D03.61, D03.62, D03.70, D03.71, D03.72, D03.8 and D03.91 have been added for albumin-bound paclitaxel. The following have been put into ranges: C34.00 – C34.92, C43.0 – C43.9, C50.011 – C50.929, C57.00 – C57.22 and D03.0 – D03.9
ICD-10-CM codes C06.80, C34.00, C34.10, C34.30, C34.80, C34.90, C34.91, C34.92, C43.10, C43.20, C43.60, C43.70, C44.101, C44.111, C44.121, C44.191, C44.201, C44.211, C44.221, C44.291, C44.310, C44.320, C44.01, C44.611, C44.621, C44.691, C44.701, C44.711, C44.721, C44.791, C46.50, C47.10, C47.20, C47.9, C49.10, C49.20,C50.019, C50.119, C50.129, C50.219, C50.319, C50.329, C50.419, C50.429, C50.519, C50.529, C50.619, C50.629, C50.819, C50.829, C50,911, C50,912, C50.919, C50.921, C50.922, C50.929, C56.9, C57.00, C57.10, C57.20, C62.00, C62.10, C62.90, C62.91, C62.92, C64.9, C65.9, C66.9, C83.99, C84.A6, C84.A8, C85.11, C85.12, C85.13, C85.14, C85.15, C85.17, C85.20, C85.97, C85.98, D03.10, D03.20, D03.60, D03.70, D49.0, D49.1, D49.2, D49.6, D49.89, Z85.00 and Z85.819, have been added for paclitaxel. The following have been put into ranges: C34.00 – C34.92, C43.0 – C43.9, C44.00 – C44.99, C47.0 – C47.9, C49.0 – C49.99, C50.011 – C50.929, C62.00-C62.92, C85.10 – C85.99 and D03.0 – D03.9.
10/01/2015 R1 The place of service guidelines for the Part B MAC have been removed. ICD-10 codes were revised to add the 7th digit for D=subsequent encounter and S=sequela, where the 7th digit, A=initial encounter, was already included for albumin-bound paclitaxel. A utilization guideline has been added.
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Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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