ERBITUX® (cetuximab)

Update your billing and coding systems to include the permanent CYRAMZA® (ramucirumab) J-code: J9308, injection, ramucirumab, 5 mg. Issued by the Centers for Medicare & Medicaid Services (CMS), this permanent J-code is effective as of January 1, 2016.

ERBITUX® (cetuximab)

Services

Patients who are prescribed ERBITUX for FDA-approved indications may be eligible for reimbursement services, financial assistance, or product through the Lilly Cares Foundation.*

The Lilly Cares Foundation, Inc., a separate nonprofit organization, provides free Lilly medications to qualifying patients. Lilly PatientOne collects information on behalf of Lilly Cares to assist Lilly Cares with its charitable mission. For more information about Lilly Cares, please visit LillyCares.com.

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Billing Information Ordering Information
HCPCS Code
Code Description
J9055 injection, cetuximab (billing unit = 10 mg)
NDC

The NDCs for ERBITUX, listed in the table below, are often necessary in addition to the appropriate J- or C-code when filing a claim for reimbursement.

Code Dosage form and strength
66733-948-23
66733-0948-23
Erbitux (cetuximab for injection) 100 mg/50 mL vial
66733-958-23
66733-0958-23
Erbitux (cetuximab for injection) 200 mg/100 mL vial
5010 Electronic Transaction Coding
  • For electronic transactions, including 837P and 837I, the NDC is to be preceded with the qualifier N4 and followed immediately by the 11-digit NDC for payers who require it
  • This is typically followed by the NDC unit of measure: UN (units), F2 (international units), GR (gram), or ML (milliliter) of the amount administered
How Supplied NDC NDC Qualifier NDC Basis of Measurement Sample NDC 5010 Format
100 mg/50 mL,
single-use vial
66733-0948-23 N4 ML N466733094823ML50
200 mg/100 mL,
single-use vial
66733-0958-23 N4 ML N466733095823ML100

The examples given for the sample NDC 5010 format demonstrate NDC quantity reporting for 1 vial of ERBITUX. The actual amount of drug used can vary based on factors such as patient weight. Currently, reporting NDC quantity varies from payer to payer, so the provider should consult each specific payer to determine the required format.

Diagnosis Codes
Colorectal cancer
ICD-10-CM Description
Malignant neoplasm of colon
C18.3 Hepatic flexure
C18.4 Transverse colon
C18.6 Descending colon
C18.7 Sigmoid colon
C18.0 Cecum
C18.1 Appendix
C18.2 Ascending colon
C18.5 Splenic flexure
Other specific sites of large intestine
C18.9 Colon, unspecified
C18.8 Overlapping sites of colon
Malignant neoplasm of rectum, rectosigmoid junction, and anus
C19 Rectosigmoid junction
C20 Rectum
Other sites of rectum, rectosigmoid junction, and anus
C21.8 Overlapping sites of rectum, anus, and anal canal
Head and neck cancer
ICD-10-CM Description
Malignant neoplasm of lip
C00.0 Upper lip, vermilion border
C00.1 Lower lip, vermilion border
C00.3 Upper lip, inner aspect
C00.4 Lower lip, inner aspect
C00.5 Lip, unspecified, inner aspect
C00.6 Commissure of lip
C00.8 Other/overlapping sites of lip
C00.2 Lip, unspecified, vermilion border
C00.9 Lip, unspecified
Malignant neoplasm of tongue
C01 Base of tongue
C02.0 Dorsal surface of tongue
C02.1 Tip and lateral border of tongue
C02.2 Ventral surface of tongue
C02.3 Anterior two-thirds of tongue, part unspecified
C02.8 Junctional zone of tongue
C02.4 Lingual tonsil
C02.8 Other sites of tongue
C02.9 Tongue, unspecified
Malignant neoplasm of gum
C03.0 Upper gum
C03.1 Lower gum
C03.9 Other sites of gum
C03.9 Gum, unspecified
Malignant neoplasm of the floor of the mouth
C04.0 Anterior portion
C04.1 Lateral portion
C04.8 Other sites of floor of mouth
C04.9 Floor of mouth, part unspecified
Malignant neoplasm of other unspecified parts of the mouth
C06.0 Cheek mucosa
C06.1 Vestibule of mouth
C05.0 Hard palate
C05.1 Soft palate
C05.2 Uvula
C05.9 Palate, unspecified
C06.2 Retromolar area
C06.89 Other specified parts of mouth
C06.9 Mouth, unspecified
C05.8 Overlapping sites of palate
C06.80 Overlapping sites of unspecified parts of mouth
Malignant neoplasm of tonsil
C09.9 Tonsil
C09.0 Tonsillar fossa
C09.1 Tonsillar pillars (anterior) (posterior)
C09.8 Overlapping sites of tonsil
Malignant neoplasm of oropharynx
C10.0 Vallecula
C10.1 Anterior aspect of epiglottis
C10.8 Junctional region of oropharynx
C10.2 Lateral wall of oropharynx
C10.3 Posterior wall of oropharynx
C10.4 Branchial cleft
C10.8 Overlapping sites
Other specified sites of oropharynx
C10.9 Oropharynx, unspecified
Malignant neoplasm of hypopharynx
C13.0 Postcricoid region
C12 Pyriform sinus
C13.1 Aryepiglottic fold, hypopharyngeal aspect
C13.2 Posterior hypopharyngeal wall
C13.8 Other specified sites of hypopharynx
C13.9 Hypopharynx, unspecified
Malignant neoplasm of other and ill-defined sites within the lip, oral cavity, and pharynx
C14.0 Pharynx, unspecified
C14.2 Waldeyer’s ring
C14.8 Other
C14.8 Ill-defined
Malignant neoplasm of nasal cavities and accessory sinuses
C30.0 Nasal cavities
C31.0 Maxillary sinus
C31.1 Ethmoidal sinus
C31.2 Frontal sinus
C31.3 Sphenoidal sinus
C31.8 Other accessory sinuses
C31.9 Accessory sinus, unspecified
Malignant neoplasm of larynx
C32.0 Glottis
C32.1 Supraglottis
C32.2 Subglottis
C32.3 Laryngeal cartilages
C32.8 Other specified sites of larynx
C32.9 Larynx, unspecified
Malignant neoplasm of other and ill-defined sites
C76.0 Head, face, and neck
Drug Administration CPT® Codes

The CPT and the APC codes that may be appropriate when administering ERBITUX appear in the table below.

CPT Code Description APC
96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug 0440
96415 Chemotherapy administration, intravenous infusion technique; each additional hour (list separately in addition to code for primary procedure) 0437
96417 Each additional sequential infusion (different substance/drug); up to 1 hour (list separately in addition to code for primary procedure) 0438
KRAS Testing Codes

The following table includes codes that are appropriate for KRAS mutation testing.

Code Description
81275 KRAS (v-Ki-ras 2 Kirsten rat sarcoma viral oncogene) (eg, carcinoma) gene analysis, variants in codons 12 and 13
81403 Molecular pathology procedure, level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in two or more independent reactions, mutation scanning, or duplication/deletion variants of 2-5 exons)
81405 Molecular pathology procedure, level 6 (eg, analysis of 6-10 exons by DNA sequence analysis, mutation scanning, or duplication/deletion variants of 11-25 exons), regionally targeted cytogenomic array assay
81479 Unlisted molecular pathology procedure
Medicare coverage of KRAS mutation testing may vary at the local level. Providers should consult their local Medicare contractor to ascertain KRAS mutation testing coverage and reimbursement for their Medicare patients.
Product Codes
Lilly Product Code LY2939777
ERBITUX UPN, GTIN CS Unit 100 mg: 00300027640013
500 mg: 00300027623016
ERBITUX UPC 100 mg: 0002-7640-01
500 mg: 0002-7623-01
National Drug Code 100 mg: 66733-948-23
200 mg: 66733-958-23

Prescribing Information including BOXED WARNINGS

This information is presented for informational purposes only and is not intended to provide reimbursement or legal advice. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. Individual coding decisions should be based upon diagnosis and treatment of individual patients. Eli Lilly and Company does not guarantee success in obtaining insurance payments. While we have made an effort to be current as of the issue date of this website, the information may not be as current or comprehensive when you view it. Providers should contact third-party payers for specific information on their coverage, coding, and payment policies. Please consult with your legal counsel or reimbursement specialist for any reimbursement or billing questions. For more information please call the Lilly PatientOne program at 1-866-472-8663.

† Typically not applicable for the administration of ERBITUX but may be used if different substances are administered sequentially.