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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.