Relevant Billing Codes for CRESEMBA® (isavuconazonium sulfate)
Properly coding claims can help facilitate timely claims processing and reduce the risk of denied claims. Coding requirements vary by payer.1 The coding systems in the following tables can assist you in coding for CRESEMBAa:
National Drug Codes (NDC)
Universal 10-digit product identifier for human drugs; each NDC identifies the labeler, product, and trade package size
|Formulation||NDC Code||Code Description|
|Oral||0469-0520-14||Capsules packaged in aluminum blister packs, 7 per sheet|
|IV||0469-0420-99||Individually packaged vials for intravenous administration|
ICD-10-CM Diagnosis Codes2
Alphanumeric classification descriptive of diseases, injuries, and causes of death
|B44.0||Invasive pulmonary aspergillosis|
|B44.1||Other pulmonary aspergillosis|
|B44.89||Other forms of aspergillosis|
4-digit codes that all hospitals use to capture cost data by department
|0250||Pharmacy, general||Some payers, such as Medicare, require certain combinations of revenue codes and Healthcare Common Procedure Coding System (HCPCS) or CPT®b codes to facilitate claims processing in the Hospital Outpatient Department (HOPD) setting. Confirm requirements with local payer policies.|
|0260||Intravenous therapy, general|
|0636||Drugs requiring detailed coding|
ICD-10-CM Procedure Codes4,c
Numeric classification descriptive of procedures performed in hospital inpatient setting
|Formulation||NDC Code||ICD-10 Code||Description|
|Oral||0469-0520-14||N/A||Capsules, 7 per sheet in aluminum blister packs|
|IV||0469-0420-99||XW03341||Introduction of Isavuconazole Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 1|
|XW04341||Introduction of Isavuconazole Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 1|
HCPCS Codes – IV formulation5
5-digit alphanumeric code
|J1833||Injection, isavuconazonium, 1 mg||Effective January 1, 2016, J1833 is used for IV formulations of CRESEMBA for billing purposes.|
a IMPORTANT INFORMATION: The coding, coverage, and payment information contained herein is gathered from various resources, general in nature, and subject to change without notice. Third-party payment for medical products and services is affected by numerous factors. It is always the provider's responsibility to determine the appropriate healthcare setting and to submit true and correct claims conforming to the requirements of the relevant payer for those products and services rendered. Pharmacies and providers submitting a claim should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by CRESEMBA Support Solutions are to assist pharmacies and other providers submitting a claim, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the pharmacy and provider that submits the claim. Information provided by CRESEMBA Support Solutions or Astellas should in no way be considered a guarantee of coverage or reimbursement for any product or service.
b American Medical Association. Current Procedural Terminology (CPT). Professional edition, 2019. All rights reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
c Section X New Technology was a section added to ICD-10-PCS beginning October 1, 2015. The new section provides a place for codes that uniquely identify procedures requested via the New Technology Application Process or that capture other new technologies not currently classified in ICD-10-PCS. The new section is simply a separate place for certain new technology procedures, such as infusion of new technology drugs. Section X does not introduce any new coding concepts or unusual guidelines for correct coding. In fact, Section X codes maintain continuity with the other sections in ICD-10-PCS by using the same root operation and body part values as their closest counterparts in other sections of ICD-10-PCS. Section X codes are standalone codes. They are not supplemental codes. Section X codes fully represent the specific procedure described in the code title, and do not require any additional codes from other sections of ICD-10-PCS. When section X contains a code title which describes a specific new technology procedure, only that X code is reported for the procedure. There is no need to report a broader, nonspecific code in another section of ICD-10-PCS. Only the IV formulation of CRESEMBA was granted an ICD-10 code.6
1. Beck DE, Margolin DA. Physician coding and reimbursement. Ochsner J. 2007;7:8-15.
2. Centers for Medicare & Medicaid Services. 2019 ICD-10-CM and GEMs. www.cms.gov/medicare/coding/icd10/2019-icd-10-cm.html. Accessed 01-31-2019.
3. Centers for Medicare & Medicaid Services. CMS manual system. www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r167cp.pdf. Accessed 01-31-2019.
4. Centers for Medicare & Medicaid Services. 2019 ICD-10-PCS and GEMS. www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-PCS.html. Accessed 01-31-2019.
5. Centers for Medicare & Medicaid Services. January 2016 Update of the Hospital Outpatient Prospective Payment System (OPPS). www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9486.pdf. Accessed 01-31-2019.
6. Centers for Medicare & Medicaid Services. Using the ICD-10-PCS New Technology Section X Codes. www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1519.pdf. Accessed 01-31-2019.
CRESEMBA® is a registered trademark of Astellas Pharma Inc.