Cyramza™ (ramucirumab) injection

HCPCS code(s)

J9999 Not otherwise classified, antineoplastic drugs
C9025 Injection, ramucirumab, 5 mg (Not all insurances would accept this code)

Cyramza™ (ramucirumab) injection, for intravenous use is a human vascular endothelial growth factor receptor 2 (VEGFR2) antagonist indicated for the treatment of advanced gastric cancer or gastro-esophageal junction adenocarcinoma, as a single agent after fluoropyrimidine or platinum-containing chemotherapy. Cyramza™ was approved by the Food and Drug Administration (FDA) on April 21, 2014.

Cyramza™ is supplied in a single-dose vial as a sterile, preservative-free solution as a concentrated solution for infusion in a 5mg/5ml (1mg / mL) single-use vial requiring dilution. As approved by the FDA the recommended dose is 8 mg/kg every two weeks administered as an intravenous infusion over 60-minutes.

In the absence of a national coverage determination (NCD) or local coverage determination (LCD), Medicare can consider coverage of a drug that is usually not self-administered per the FDA indication when administered incident to a physician service or in the hospital setting. The medical record must clearly document the patient’s prior chemotherapy regimens and must also support the diagnosis of advanced gastric cancer or gastro-esophageal junction adenocarcinoma using the appropriate ICD-9-CM code(s) of 150.0-150.9 (Malignant neoplasm of esophagus), 151.0-151.9 (Malignant neoplasm of stomach), 235.5 (Other and unspecified digestive organs) and FDA guidance for use as well as the administration.

Reference: http://medicare.fcso.com/Coverage_News/274811.asp

Also see:

http://www.aetna.com/cpb/medical/data/800_899/0883.html