Relevant Billing Codes for CRESEMBA® (isavuconazonium sulfate) capsules
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)2
Universal 10-digit product identifier for human drugs; each NDC identifies the labeler, product, and trade package size
|Formulation||NDC Code||Code Description|
|Oral||0469-0520-02||14-count carton (contains two individual aluminum blister packs of 7 capsules per sheet with desiccant)|
|Oral||0469-2860-35||35-count carton (contains seven individual aluminum child-resistant blister packs of 5 capsules per sheet with desiccant)|
|IV||0469-0420-01||Individually packaged single-dose vial|
ICD-10-CM Diagnosis Codes3
Alphanumeric classification descriptive of diseases, injuries, and causes of death
|B44.0||Invasive pulmonary aspergillosis|
|B44.1||Other pulmonary aspergillosis|
|B44.81||Allergic bronchopulmonary 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|
HCPCS Codes – IV formulation5
5-digit alphanumeric code
|J1833||Injection, isavuconazonium, 1 mg||For use of IV formulation.|
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, 2022. 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.
1. Beck DE, Margolin DA. Physician coding and reimbursement. Ochsner J 2007;7:8-15.
2. CRESEMBA [package insert]. Northbrook, IL: Astellas Pharma US, Inc.
3. Centers for Disease Control and Prevention. ICD-10-CM tabular list of diseases and injuries 2022. https://www.cdc.gov/nchs/icd/icd10cm.htm. Accessed 11-18-2021.
4. Centers for Medicare & Medicaid Services. CMS manual system. www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r167cp.pdf. Accessed 11-18-2021.
5. Centers for Medicare & Medicaid Services. 2022 alpha-numeric HCPCS file. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update. Accessed 11-18-2021.
CRESEMBA® is a registered trademark of Astellas US LLC.