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Sample Coding & Billing
Find information on coding and billing for OCREVUS
Treatment with OCREVUS (ocrelizumab) is eligible for reimbursement under most major commercial insurance plans as well as Medicare and Medicaid programs. The following tables include sample coding information when filing claims for reimbursement for OCREVUS.
Sample coding
Diagnosis: ICD-10-CM
| CODE | DESCRIPTION |
|---|---|
| G35 | Multiple sclerosis |
Drug: HCPCS
| CODE | DESCRIPTION |
|---|---|
| J2350 | Injection, ocrelizumab, 1 mg |
Home Infusion: HCPCS
| CODE | DESCRIPTION |
|---|---|
| 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) |
| 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 |
Drug: NDC
| CODE | DESCRIPTION |
|---|---|
| 10 Digit
50242-150-01 | ocrelizumab, 300 mg vial |
| 11 Digit
50242-0150-01 |
Administration procedures: CPT*
| CODE | DESCRIPTION |
|---|---|
| 96413 | Chemotherapy administration, intravenous
infusion technique; up to 1 hour, single or initial
substance/drug |
| 96415 | Chemotherapy administration, intravenous
infusion technique; each additional hour (List separately in
addition to code for primary procedure) |
| 96365 | Intravenous infusion, for therapy,
prophylaxis, or diagnosis (specify substance or drug); initial,
up to 1 hour |
| 96366 | Intravenous infusion, for therapy,
prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary
procedure) |
| 99601 | Home infusion/specialty drug
administration, per visit (up to 2 hours) |
| 99602 | Home infusion/specialty drug
administration, per visit (up to 2 hours); each additional hour
(List separately in addition to code for primary
procedure) |
These codes are not all-inclusive; appropriate codes can vary by patient, setting of care and payer. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
The sample coding guide is also available for download for use in your practice.
*For payers who do not yet recognize OCREVUS as
approved for chemotherapy administration codes 96413 and 96415,
other administration codes, such as 96365 and 96366, may be used
depending on individual payer policy.
CPT=Current Procedural
Terminology; HCPCS=Healthcare Common Procedure Coding System;
ICD-10-CM=International Classification of Diseases, 10th Revision,
Clinical Modification; NDC=National Drug Code.
Appealing a Claims Denial
Resources for appealing a denied claim
If your patient’s health insurance plan has issued a denial, your Genentech reimbursement representative or Genentech Access Solutions Specialist can provide resources as you prepare an appeal submission, as per your patient’s plan requirements.
As a part of those resources, there are several sample letter options to suit varying circumstances. Options include Sample Appeal Letters and Sample Letters of Medical Necessity for new patients, remaining patients, and patients converting to OCREVUS.†
Considerations for composing an appeal letter and a sample appeal letter are available at genentech-access.com.
†Appeals cannot be completed or submitted by Genentech Access Solutions on your behalf.
