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 its approved indications may be eligible for reimbursement services, financial assistance, or replacement product through the Lilly Cares Foundation.*

The Lilly Cares Foundation, Inc., an independent 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.

Learn more
Billing Information Ordering Information
HCPCS Code

The HCPCS code for ERBITUX is J9055 (injection, cetuximab, 10 mg).

Use the following claim formats when ERBITUX is administered to patients on an outpatient basis and billed to health plans (10 mg=1 billing unit):

  • Physician office: CMS-1500 (paper format) or ASC 837P (electronic format)
  • Hospital outpatient: UB-04 (CMS-1450) (paper format) or ASC 837I (electronic format)

All of the coding information is applicable to outpatient procedures only. Typically, there is no need to further identify ERBITUX when billing with HCPCS code J9055.

NDCs

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.

66733-948-23
66733-0948-23
100 mg/50 mL, single-use vial
100 mg vial=10 billing units
66733-958-23
66733-0958-23
200 mg/100 mL, single-use vial
200 mg vial=20 billing units
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-9-CM ICD-10-CM Description
Malignant neoplasm of colon
153.0 C18.3 Hepatic flexure
153.1 C18.4 Transverse colon
153.2 C18.6 Descending colon
153.3 C18.7 Sigmoid colon
153.4 C18.0 Cecum
153.5 C18.1 Appendix
153.6 C18.2 Ascending colon
153.7 C18.5 Splenic flexure
153.8 Other specific sites of large intestine
153.9 C18.9 Colon, unspecified
C18.8 Overlapping sites of colon
Malignant neoplasm of rectum, rectosigmoid junction, and anus
154.0 C19 Rectosigmoid junction
154.1 C20 Rectum
154.8 Other sites of rectum, rectosigmoid junction, and anus
C21.8 Overlapping sites of rectum, anus, and anal canal
Head and neck cancer
ICD-9-CM ICD-10-CM Description
Malignant neoplasm of lip
140.0 C00.0 Upper lip, vermilion border
140.1 C00.1 Lower lip, vermilion border
140.3 C00.3 Upper lip, inner aspect
140.4 C00.4 Lower lip, inner aspect
140.5 C00.5 Lip, unspecified, inner aspect
140.6 C00.6 Commissure of lip
140.8 C00.8 Other/overlapping sites of lip
140.9 C00.2 Lip, unspecified, vermilion border
C00.9 Lip, unspecified
Malignant neoplasm of tongue
141.0 C01 Base of tongue
141.1 C02.0 Dorsal surface of tongue
141.2 C02.1 Tip and lateral border of tongue
141.3 C02.2 Ventral surface of tongue
141.4 C02.3 Anterior two-thirds of tongue, part unspecified
141.5 C02.8 Junctional zone of tongue
141.6 C02.4 Lingual tonsil
141.8 C02.8 Other sites of tongue
141.9 C02.9 Tongue, unspecified
Malignant neoplasm of gum
143.0 C03.0 Upper gum
143.1 C03.1 Lower gum
143.8 C03.9 Other sites of gum
143.9 C03.9 Gum, unspecified
Malignant neoplasm of the floor of the mouth
144.0 C04.0 Anterior portion
144.1 C04.1 Lateral portion
144.8 C04.8 Other sites of floor of mouth
144.9 C04.9 Floor of mouth, part unspecified
Malignant neoplasm of other unspecified parts of the mouth
145.0 C06.0 Cheek mucosa
145.1 C06.1 Vestibule of mouth
145.2 C05.0 Hard palate
145.3 C05.1 Soft palate
145.4 C05.2 Uvula
145.5 C05.9 Palate, unspecified
145.6 C06.2 Retromolar area
145.8 C06.89 Other specified parts of mouth
145.9 C06.9 Mouth, unspecified
C05.8 Overlapping sites of palate
C06.80 Overlapping sites of unspecified parts of mouth
Malignant neoplasm of tonsil
146.0 C09.9 Tonsil
146.1 C09.0 Tonsillar fossa
146.2 C09.1 Tonsillar pillars (anterior) (posterior)
C09.8 Overlapping sites of tonsil
Malignant neoplasm of oropharynx
146.3 C10.0 Vallecula
146.4 C10.1 Anterior aspect of epiglottis
146.5 C10.8 Junctional region of oropharynx
146.6 C10.2 Lateral wall of oropharynx
146.7 C10.3 Posterior wall of oropharynx
146.8 C10.4 Branchial cleft
C10.8 Overlapping sites
Other specified sites of oropharynx
146.9 C10.9 Oropharynx, unspecified
Malignant neoplasm of hypopharynx
148.0 C13.0 Postcricoid region
148.1 C12 Pyriform sinus
148.2 C13.1 Aryepiglottic fold, hypopharyngeal aspect
148.3 C13.2 Posterior hypopharyngeal wall
148.8 C13.8 Other specified sites of hypopharynx
148.9 C13.9 Hypopharynx, unspecified
Malignant neoplasm of other and ill-defined sites within the lip, oral cavity, and pharynx
149.0 C14.0 Pharynx, unspecified
149.1 C14.2 Waldeyer’s ring
149.8 C14.8 Other
149.9 C14.8 Ill-defined
Malignant neoplasm of nasal cavities and accessory sinuses
160.0 C30.0 Nasal cavities
160.2 C31.0 Maxillary sinus
160.3 C31.1 Ethmoidal sinus
160.4 C31.2 Frontal sinus
160.5 C31.3 Sphenoidal sinus
160.8 C31.8 Other accessory sinuses
160.9 C31.9 Accessory sinus, unspecified
Malignant neoplasm of larynx
161.0 C32.0 Glottis
161.1 C32.1 Supraglottis
161.2 C32.2 Subglottis
161.3 C32.3 Laryngeal cartilages
161.8 C32.8 Other specified sites of larynx
161.9 C32.9 Larynx, unspecified
Malignant neoplasm of other and ill-defined sites
195.0 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 are encouraged to 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 are encouraged to 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.