Multiple sclerosis (MS) patients frequently receive prescriptions for ocrelizumab, so healthcare providers must understand which codes apply to its administration in order to bill or secure insurance coverage. Below is an outline of these relevant Ocrelizumab codes with explanations as they pertain to administration. Please see the below-mentioned Ocrevus CPT code (Ocrelizumab) Billing and coding guideline.
Dosage & Frequency
Ocrevus (Ocrelizumab) can help treat different sclerosis effectively. For best results, it should be used in two parts: an induction phase, during which 300 mg of Ocrevus should be given intravenously starting in week 0 and again every two weeks; and a maintenance phase, during which 600 mg of Ocrevus should be taken twice a week for 6 months. This is similar to how Ocrevus is used to treat many types of sclerosis: Dosage Schedule
Induction Phase:
300 mg intravenously at week 0 and again at week 2.
Maintenance Phase:
After the inducing phase, once-every-6-month administration of 600 mg intravenously helps effectively manage this condition by relieving acute symptoms while providing long-term control of long-term effects.
Prior Authorization
ICD-10-CM Diagnosis G35:
This code is used specifically for diagnosing Multiple Sclerosis.
| ICD-10-CM | Description |
Code History |
| G35 | Multiple sclerosis | Change Effective Date:10/01/2015 |
| Disseminated multiple sclerosis | ||
| Generalized multiple sclerosis | ||
| Multiple sclerosis NOS | ||
| Multiple sclerosis of brain stem | ||
| Multiple sclerosis of cord |
HCPCS (ocrelizumab Drug): J2350
| HCPCS | Description |
Code History |
| J2350 | Injection, ocrelizumab, 1 mg | Change Effective Date:10/01/2018 |
Code: J2350
Description: Injection, ocrelizumab, 1 mg
Unit: 1 MG
Payment: $58.756
Pay quarter: Q2 2024
Home Infusion Therapy Codes
| HCPCS | Description |
Code History |
| S9329 | Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with S9330 or S9331) |
This code was most recently made effective or revised prior to: (01/01/2004). |
| S9379 | Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
This code was most recently made effective or revised prior to: (01/01/2004). |
Administration Procedure Codes
| HCPCS | Description | Code History |
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour | This code has been effective since: (01/01/2009). |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) | This code has been effective since: (01/01/2009). |
| 96413 | Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug | This code has been effective since: (01/01/2006). |
| 96415 | Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure) | This code has been effective since: (01/01/2006). |
| 99601 | Home infusion/specialty drug administration, per visit (up to 2 hours); | This code has been effective since: (01/01/2004). |
| 99602 | Home infusion/specialty drug administration, per visit (up to 2 hours); each additional hour (List separately in addition to code for primary procedure) | This code has been effective since: (01/01/2004). |
Use of the JZ Modifier
Effective July 1, 2023, the Centers for Medicare and Medicaid Services (CMS) mandates the use of the JZ modifier to signify that an entity has not wasted any units.
National Drug Code (NDC)
The National Drug Codes provide Ocrelizumab medication codes in both 10-digit and 11-digit formats:
- 10-Digit-NDC: 50242-150-01
- 11- Digit-NDC: 50242-0150-01
These codes correspond to a 300 mg single-dose vial of Ocrelizumab.
Billable NDCs
50242-0150-01
OCREVUS (GENENTECH, INC.)
300 MG
Publication 100-2’s Chapter 15, “SS50 Drugs and Biologicals,” details Medicare’s coverage of outpatient (Part B) drugs. Additionally, specific drugs may have National Coverage Determinations (NCD), Local Coverage Articles (LCAs), or all three; we expect compliance when applicable; you can find them online at https://www.cms.gov/medicare-coverage-database/search.aspx.. Health plans may also cover additional indications at their discretion.
Medicare Part B Covered Diagnosis Codes (applicable to existing NCD/LCD/LCA): N/A
|
Medicare Part B Administrative Contractor (MAC) Jurisdictions |
||
| Jurisdiction |
Applicable State/US Territory |
Contractor |
| E (1) |
CA, HI, NV, AS, GU, CNMI |
Noridian Healthcare Solutions, LLC |
| F (2 & 3) |
AK, WA, OR, ID, ND, SD, MT, WY, UT, AZ |
Noridian Healthcare Solutions, LLC |
| 5 |
KS, NE, IA, MO |
Wisconsin Physicians Service Insurance Corp (WPS) |
| 6 |
MN, WI, IL |
National Government Services, Inc. (NGS) |
| H (4 & 7) |
LA, AR, MS, TX, OK, CO, NM |
Novitas Solutions, Inc. |
| 8 |
MI, IN |
Wisconsin Physicians Service Insurance Corp (WPS) |
| N (9) |
FL, PR, VI |
First Coast Service Options, Inc. |
| J (10) |
TN, GA, AL |
Palmetto GBA, LLC |
| M (11) |
NC, SC, WV, VA (excluding below) |
Palmetto GBA, LLC |
| L (12) |
DE, MD, PA, NJ, DC (includes Arlington & Fairfax counties and the city of Alexandria in VA) |
Novitas Solutions, Inc. |
| K (13 & 14) |
NY, CT, MA, RI, VT, ME, NH |
National Government Services, Inc. (NGS) |
| 15 |
KY, OH |
CGS Administrators, LLC |
Here are the key points regarding the administration of OCREVUS:
Alternative Codes Available:
If payer policies do not approve OCREVUS under chemotherapy administration codes 96413 and 96415, they may use alternatives such as 96365 and 96366.
Variability in Codes:
Appropriate codes may vary according to a patient’s specific circumstances, care setting requirements, and payer specifications.
Provider Responsibility:
Providers are responsible for correctly coding claim submissions.
Payer Consultation Required:
Always consult with the payer to confirm and understand any specific billing requirements or special coding considerations.
No Guarantee from Billing and Coding compliance:
Compliance with billing and coding doesn’t guarantee reimbursement or coverage for items and services purchased or rendered.
Risk with Unspecified Codes:
Numerous payers do not recognise unspecified codes before using any unspecified ones with them.
For safety information, please see the full Prescribing Information and Medication Guide.
Frequently Asked Questions (FAQ):
What is CPT code J2350 used for?
CPT code J2350 the purpose of this billing code is to charge for an injection of Ocrelizumab (1 mg). Ocrelizumab is commonly prescribed to treat multiple sclerosis.
What is J code J9358?
J code J9358 this billing code is used when purchasing the Fam-Trastuzumab Deruxtecan-NxKi 1 mg medication used to treat certain forms of breast cancer.
What is CPT J2356?
CMS categorizes CPT J2356—Injection—Tezepelumab-ekko 1 mg as part of Drugs Administered by Injection.
What is CPT code J2506?
When billing Pegfilgrastim 6 mg for cancer chemotherapy treatments like radiotherapy. We use CPT code J2506. Pegfilgrastim stimulates white blood cell production to prevent infections while cancer treatments such as radiotherapy take place.
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