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 PADCEV^a:

^aIMPORTANT 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 (or any other provider submitting a claim) should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by PADCEV Support Solutions are to assist providers, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider and information provided by PADCEV Support Solutions, Astellas or Seagen should in no way be considered a guarantee of coverage or reimbursement for any product or service.

^bAmerican Medical Association. Current Procedural Terminology (CPT). Professional edition, 2023. 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.

References

1. Beck DE, Margolin DA, Physician coding and reimbursement. Ochsner J 2007;7:8-15.

2. Centers for Medicare & Medicaid Services. 2023 alpha-numeric HCPCS file. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update. Accessed 07-19-2023.

3. PADCEV [package insert]. Northbrook, IL: Astellas Pharma US, Inc.

4. U.S. Food and Drug Administration. National drug code database background information. https://www.fda.gov/drugs/development-approval-process-drugs/national-drug-code-database-background-information. Accessed 07-19-2023.

5. American Medical Association. CPT^® 2023 Professional Edition. Chicago, IL: American Medical Association, 2022.

6. Centers for Disease Control and Prevention. ICD-10-CM tabular list of diseases and injuries 2023. https://www.cms.gov/medicare/icd-10/2023-icd-10-cm. Accessed 07-19-2023.