BMS Access Support® may help support patient access by conducting benefits reviews and offering prior authorization and appeals process assistance for enrolled patients. Additionally, the information below provides product-specific billing and diagnosis codes, reimbursement and coding guides, distribution information, and additional coverage support offerings. To view available coding and coverage information, please select your patient’s prescribed medication.
Additional eligibility criteria and terms may apply. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.
Read more about our coverage support offeringsBenefits Reviews
*BMS Access Support Data - Benefits review. Accessed August 2022.
Prior Authorization (PA) and Appeals Assistance
Annual Reverification
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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Healthcare Common Procedure Coding System (HCPCS) Code1
Issued by CMS
J9264 Copy | Injection, paclitaxel protein-bound particles, 1 mg |
Providers and suppliers are required to report the JW modifier on Part B drug claims for discarded drugs and biologicals. Also, providers and suppliers must document the amount of discarded drugs or biologicals in Medicare beneficiaries’ medical records.2
Revenue Codes (for Use in the Hospital Outpatient Setting)3
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)4,†
96413 Copy | Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug |
National Drug Codes (NDC)5
Issued by the FDA
Note: Payers require the submission of the 11-digit NDC on healthcare claim forms. Please use the 11-digit codes shown here.
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)6
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 |
C50.0 Copy | Malignant neoplasm of nipple and areola |
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 | Malignant neoplasm of pancreas |
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 |
C25.4 | Malignant neoplasm of endocrine pancreas |
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 |
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 ©2023 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:
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.asdhealthcare.com |
Cardinal Health Specialty Pharmaceutical Distribution | 1-877-453-3972 | https://specialtyonline.cardinalhealth.com |
CuraScript Specialty Distribution | 1-877-599-7748 | https://www.curascriptsd.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.mdspecialtydist.com |
Oncology Supply | 1-800-633-7555 | https://www.oncologysupply.com |
Wholesalers | Phone Orders | Fax Orders and Website |
Amerisource Bergen Corporation |
1-844-222-2273 | https://abcorder.amerisourcebergen.com |
Cardinal Health Inc. | 1-800-964-5227 | https://www.cardinalhealth.com/en/login.html |
DMS Pharmaceutical Group, Inc. | 1-877-788-1100 | Fax: 1-847-518-1105 https://www.dmspharma.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.mdwebportal.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://www.cardinalhealth.pr |
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 12/23.
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 LetterFor 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 LetterFor the first-line treatment of patients with metastatic adenocarcinoma of the pancreas, in combination with gemcitabine
View LetterPlease see U.S. Full Prescribing Information for ABRAXANE, including Boxed WARNING.