Coverage Indications, Limitations, and/or Medical Necessity
CPT/HCPCS Codes
Group 1 Paragraph: N/A
Group 1 Codes:
CODE DESCRIPTION
J9181 INJECTION, ETOPOSIDE, 10 MG
References:
https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33723&ver=15&DocType=2&bc=AAIAAAAAAAAA&
Etoposide (Etopophos®, Toposar®, VePesid®, VP-16)-J9181
Etoposide is a podophyllotoxin which inhibits DNA synthesis prior to mitosis by blocking topoisomerase II.
Etoposide is FDA approved for the following indications:
Etoposide is a podophyllotoxin which inhibits DNA synthesis prior to mitosis by blocking topoisomerase II.
Etoposide is FDA approved for the following indications:
- Management of refractory testicular tumors, in combination with other approved chemotherapeutic agents.
- In combination with other approved chemotherapeutic agents as first-line treatment in patients with small cell lung cancer.
Etoposide will be covered when provided for its FDA approved uses, as well as for the Treatment of the following off-labeled indications:
- Primary peritoneal carcinoma
- Fallopian tube carcinoma
- Gastric carcinoma
- Hepatoblastoma
- Neuroblastoma
- Non-small cell lung carcinoma
- Testicular cancer
- Thymoma
- Osteosarcoma
- Ewing’s sarcoma
- Soft tissue sarcomas
- Cutaneous T cell lymphomas
- Breast carcinoma
- AIDS associated Kaposi’s sarcoma
- Endometrial carcinoma
- Ovarian germ cell tumors
- Bladder carcinoma
- Wilms’ Tumor
- Retinoblastoma
- Adrenocortical carcinoma
- Acute lymphocytic leukemia
- Acute nonlymphocytic leukemia
- Chronic myelocytic leukemia
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
- Multiple myeloma
- Primary brain tumor
- Gestational trophoblastic tumor
- Cancer of Unknown Primary site (CUPs)
- Trophoblastic neoplasm
- Myelodysplastic syndromes (MDS)
- Neuroendocrine tumors (malignant poorly differentiated)
- For Merkel cell carcinoma in combination with carboplatin or cisplatin as a consideration for adjuvant treatment with or without radiation therapy for N+ disease
- For Merkel cell carcinoma in combination with carboplatin or cisplatin as treatment for distant metastatic disease or disseminated recurrence with or without surgery or radiation therapy
CPT/HCPCS Codes
Group 1 Paragraph: N/A
Group 1 Codes:
CODE DESCRIPTION
J9181 INJECTION, ETOPOSIDE, 10 MG
References:
https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33723&ver=15&DocType=2&bc=AAIAAAAAAAAA&
This post first appeared on Interventional Radiology Medical Coding - Learn How To Code, please read the originial post: here
