health care professionals - tecentriq billing codes...here for your reference. 10-digit 11-digit...
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1 of 3
for ® (atezolizumab)
Please see full Prescribing Information for additional Important Safety Information.
Breast Cancer
TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CM
C50.011–C50.019 C50.111–C50.119 C50.211–C50.219 C50.311–C50.319 C50.411–C50.419 C50.511–C50.519 C50.611–C50.619 C50.811–C50.819 C50.911–C50.919
Malignant neoplasm of the female breast
C50.021–C50.029 C50.121–C50.129 C50.221–C50.229 C50.321–C50.329 C50.421–C50.429 C50.521–C50.529 C50.621–C50.629 C50.821–C50.829 C50.921–C50.929
Malignant neoplasm of the male breast
Drug: HCPCS J9022 Injection, atezolizumab, 10 mg
Drug: NDC
Note: Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference.
10-digit 11-digit
50242-917-01 50242-0917-01 1200 mg/20 mL single-dose vial
50242-918-01 50242-0918-01 840 mg/14 mL single-dose vial
Administration procedures: CPT
96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
96417
Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)
SAMPLE CODING
CPT=Current Procedural Terminology; HCPCS=Healthcare Common Procedure Coding System; ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification; NDC=National Drug Code.
These codes are not all-inclusive; appropriate codes can vary by patient, setting of care and payer. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
Many payers will not accept unspecified codes. If you use an unspecified code, please check with your payer.
for ® (atezolizumab)
2 of 3Please see full Prescribing Information for additional Important Safety Information.
INDICATIONS & IMPORTANT SAFETY INFORMATIONINDICATIONSmUC
TECENTRIQ is indicated for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma who:
• Are not eligible for cisplatin-containing chemotherapy and whose tumors express PD-L1 (PD-L1–stained tumor-infiltrating immune cells [IC] covering ≥5% of the tumor area), as determined by an FDA-approved test, or
• Are not eligible for any platinum-containing chemotherapy regardless of PD-L1 status, or
• Have disease progression during or following any platinum-containing chemotherapy, or within 12 months of neoadjuvant or adjuvant chemotherapy
This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).
NSCLC
TECENTRIQ, in combination with bevacizumab, paclitaxel, and carboplatin, is indicated for the first-line treatment of adult patients with metastatic non-squamous, non-small cell lung cancer (nsqNSCLC) with no EGFR or ALK genomic tumor aberrations.
TECENTRIQ, in combination with paclitaxel protein-bound and carboplatin, is indicated for the first-line treatment of adult patients with metastatic non-squamous NSCLC with no EGFR or ALK genomic tumor aberrations.
TECENTRIQ, as a single agent, is indicated for the treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) who have disease progression during or following platinum-containing chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for NSCLC harboring these aberrations prior to receiving TECENTRIQ.
mTNBC
TECENTRIQ, in combination with paclitaxel protein-bound, is indicated for the treatment of adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (TNBC) whose tumors express PD-L1 (PD-L1–stained tumor-infiltrating immune cells [IC] of any intensity covering ≥1% of the tumor area), as determined by an FDA-approved test.
This indication is approved under accelerated approval based on progression-free survival. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).
SCLC
TECENTRIQ, in combination with carboplatin and etoposide, is indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC).
IMPORTANT SAFETY INFORMATIONSerious Adverse Reactions
Please refer to the full Prescribing Information for important dose management information specific to adverse reactions.
• Immune-mediated pneumonitis. Immune-mediated pneumonitis or interstitial lung disease, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for Grade 3 or 4 pneumonitis
• Immune-mediated hepatitis. Immune-mediated hepatitis and liver test abnormalities, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for AST or ALT elevations more than 8 times the upper limit of normal or total bilirubin more than 3 times the upper limit of normal
• Immune-mediated colitis. Immune-mediated diarrhea or colitis have occurred. Permanently discontinue TECENTRIQ for Grade 4 diarrhea or colitis
• Immune-mediated endocrinopathies. Thyroid disorders, adrenal insufficiency, type 1 diabetes mellitus, including diabetic ketoacidosis, and hypophysitis/hypopituitarism have occurred
• Other immune-mediated adverse reactions. TECENTRIQ can cause severe and fatal immune-mediated adverse reactions. These immune-mediated reactions may involve any organ system. Permanently discontinue TECENTRIQ for Grade 4 immune-mediated adverse reactions involving a major organ
• Infections. Severe infections, including fatal cases, have occurred
• Infusion-related reactions. Severe or life-threatening infusion-related reactions have occurred. Permanently discontinue TECENTRIQ in patients with Grade 3 or 4 infusion-related reactions
3 of 3
TECENTRIQ®, its logo and the Access Solutions logo are registered trademarks of Genentech, Inc.
© 2019 Genentech USA, Inc. So. San Francisco, CA All rights reserved. M-US-00001885(v1.0) 11/19
Please see full Prescribing Information for additional Important Safety Information.
for ® (atezolizumab)
IMPORTANT SAFETY INFORMATION (cont)Serious Adverse Reactions (cont)
• Embryo-fetal toxicity. TECENTRIQ can cause fetal harm in pregnant women. Verify pregnancy status prior to initiating TECENTRIQ. Advise females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TECENTRIQ and for at least 5 months after the last dose
• Advise female patients not to breastfeed while taking TECENTRIQ and for at least 5 months after the last dose
Most Common Adverse Reactions
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ alone were fatigue/asthenia (48%), decreased appetite (25%), nausea (24%), cough (22%), and dyspnea (22%).
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ in combination with other antineoplastic drugs for NSCLC and SCLC were fatigue/asthenia (49%), nausea (38%), alopecia (35%), constipation (29%), diarrhea (28%), and decreased appetite (27%).
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ with paclitaxel protein-bound for mTNBC were alopecia (56%), peripheral neuropathies (47%), fatigue (47%), nausea (46%), diarrhea (33%), anemia (28%), constipation (25%), cough (25%), headache (23%), neutropenia (21%), vomiting (20%), and decreased appetite (20%).
You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1- 888-835-2555.
Please see full Prescribing Information for additional Important Safety Information.
1 of 2
for ®
(atezolizumab)
Please see full Prescribing Information for additional Important Safety Information.
Non-small Cell Lung Cancer (NSCLC)
TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CM
C33 Malignant neoplasm of trachea
C34.00–C34.02 Malignant neoplasm of bronchus and lung; main bronchus
C34.10–C34.12 Malignant neoplasm of bronchus and lung; upper lobe
C34.2 Malignant neoplasm of bronchus and lung; middle lobe
C34.30–C34.32 Malignant neoplasm of bronchus and lung; lower lobe
C34.80–C34.82 Malignant neoplasm of bronchus and lung; overlapping sites
C34.90–C34.92 Malignant neoplasm of bronchus and lung; unspecified part
Drug: HCPCS J9022 Injection, atezolizumab, 10 mg
Drug: NDC
Note: Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference.
10-digit 11-digit
50242-917-01 50242-0917-01 1200 mg/20 mL single-dose vial
50242-918-01 50242-0918-01 840 mg/14 mL single-dose vial
Administration procedures: CPT
96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
96417
Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)
SAMPLE CODING
CPT=Current Procedural Terminology; HCPCS=Healthcare Common Procedure Coding System; ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification; NDC=National Drug Code.
These codes are not all-inclusive; appropriate codes can vary by patient, setting of care and payer. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
Many payers will not accept unspecified codes. If you use an unspecified code, please check with your payer.
for ®
(atezolizumab)
2 of 2
INDICATIONS & IMPORTANT SAFETY INFORMATIONINDICATIONS TECENTRIQ, as a single agent, is indicated for the first-line treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have high PD-L1 expression (PD-L1–stained ≥50% of tumor cells [TC ≥50%] or PD-L1–stained tumor-infiltrating immune cells [IC] covering ≥10% of the tumor area [IC ≥10%]), as determined by an FDA-approved test, with no EGFR or ALK genomic tumor aberrations.
TECENTRIQ, in combination with bevacizumab, paclitaxel, and carboplatin, is indicated for the first-line treatment of adult patients with metastatic non-squamous, non-small cell lung cancer (nsqNSCLC) with no EGFR or ALK genomic tumor aberrations.
TECENTRIQ, in combination with paclitaxel protein-bound and carboplatin, is indicated for the first-line treatment of adult patients with metastatic non-squamous NSCLC with no EGFR or ALK genomic tumor aberrations.
TECENTRIQ, as a single agent, is indicated for the treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) who have disease progression during or following platinum-containing chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for NSCLC harboring these aberrations prior to receiving TECENTRIQ.
IMPORTANT SAFETY INFORMATION Serious Adverse Reactions
Please refer to the full Prescribing Information for important dose management information specific to adverse reactions.
• Immune-mediated pneumonitis. Immune-mediated pneumonitis or interstitial lung disease, including fatal cases, have occurred. Permanentlydiscontinue TECENTRIQ for Grade 3 or 4 pneumonitis
• Immune-mediated hepatitis. Immune-mediated hepatitis and liver test abnormalities, including fatal cases, have occurred. Permanentlydiscontinue TECENTRIQ for AST or ALT elevations more than 8 times the upper limit of normal or total bilirubin more than 3 times the upperlimit of normal
• Immune-mediated colitis. Immune-mediated diarrhea or colitis have occurred. Permanently discontinue TECENTRIQ for Grade 4 diarrheaor colitis
• Immune-mediated endocrinopathies. Thyroid disorders, adrenal insufficiency, type 1 diabetes mellitus, including diabetic ketoacidosis, andhypophysitis/hypopituitarism have occurred
• Other immune-mediated adverse reactions. TECENTRIQ can cause severe and fatal immune-mediated adverse reactions. These immune-mediated reactions may involve any organ system. Permanently discontinue TECENTRIQ for Grade 4 immune-mediated adverse reactionsinvolving a major organ
• Infections. Severe infections, including fatal cases, have occurred
• Infusion-related reactions. Severe or life-threatening infusion-related reactions have occurred. Permanently discontinue TECENTRIQ inpatients with Grade 3 or 4 infusion-related reactions
• Embryo-fetal toxicity. TECENTRIQ can cause fetal harm in pregnant women. Verify pregnancy status prior to initiating TECENTRIQ. Advisefemales of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception duringtreatment with TECENTRIQ and for at least 5 months after the last dose
• Advise female patients not to breastfeed while taking TECENTRIQ and for at least 5 months after the last dose
Most Common Adverse Reactions
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ alone were fatigue/asthenia (48%), decreased appetite (25%), nausea (24%), cough (22%), and dyspnea (22%).
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ in combination with other antineoplastic drugs for NSCLC and SCLC were fatigue/asthenia (49%), nausea (38%), alopecia (35%), constipation (29%), diarrhea (28%), and decreased appetite (27%).
You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1- 888-835-2555.
Please see full Prescribing Information for additional Important Safety Information.
TECENTRIQ®, its logo and the Access Solutions logo are registered trademarks of Genentech, Inc.
© 2020 Genentech USA, Inc. So. San Francisco, CA All rights reserved. M-US-00004963(v1.0) 05/20
Please see full Prescribing Information for additional Important Safety Information.
1 of 3
for ® (atezolizumab)
Please see full Prescribing Information for additional Important Safety Information.
Small Cell Lung Cancer (SCLC)
TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CM
C33 Malignant neoplasm of trachea
C34.00–C34.02 Malignant neoplasm of bronchus and lung; main bronchus
C34.10–C34.12 Malignant neoplasm of bronchus and lung; upper lobe
C34.2 Malignant neoplasm of bronchus and lung; middle lobe
C34.30–C34.32 Malignant neoplasm of bronchus and lung; lower lobe
C34.80–C34.82 Malignant neoplasm of bronchus and lung; overlapping sites
C34.90–C34.92 Malignant neoplasm of bronchus and lung; unspecified part
ICD-10-PCS
(For NTAP-eligible cases effective October 1, 2020)
XW033D6 Introduction of atezolizumab antineoplastic into peripheral vein, percutaneous approach, new technology group 6
XW043D6 Introduction of atezolizumab antineoplastic into central vein, percutaneous approach, new technology group 6
Drug: HCPCS J9022 Injection, atezolizumab, 10 mg
Drug: NDC
Note: Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference.
10-digit 11-digit
50242-917-01 50242-0917-01 1200 mg/20 mL single-dose vial
50242-918-01 50242-0918-01 840 mg/14 mL single-dose vial
Administration procedures: CPT
96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
96417
Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)
CPT=Current Procedural Terminology; HCPCS=Healthcare Common Procedure Coding System; ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification; ICD-10-PCS=International Classification of Diseases, 10th Revision, Procedure Coding System; NDC=National Drug Code; NTAP=New Technology Add-On Payment.
SAMPLE CODING
These codes are not all-inclusive; appropriate codes can vary by patient, setting of care and payer. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
Many payers will not accept unspecified codes. If you use an unspecified code, please check with your payer.
3 of 3
TECENTRIQ® and the Access Solutions logo are registered trademarks of Genentech, Inc.
© 2020 Genentech USA, Inc. So. San Francisco, CA All rights reserved. M-US-00004125(v2.0) 10/20
Please see full Prescribing Information for additional Important Safety Information.
for ® (atezolizumab)
INDICATIONS & IMPORTANT SAFETY INFORMATIONINDICATIONSSCLC
TECENTRIQ, in combination with carboplatin and etoposide, is indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC).
IMPORTANT SAFETY INFORMATIONSerious Adverse Reactions
Please refer to the full Prescribing Information for important dose management information specific to adverse reactions.
• Immune-mediated pneumonitis. Immune-mediated pneumonitis or interstitial lung disease, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for Grade 3 or 4 pneumonitis
• Immune-mediated hepatitis. Immune-mediated hepatitis and liver test abnormalities, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for AST or ALT elevations more than 8 times the upper limit of normal or total bilirubin more than 3 times the upper limit of normal
• Immune-mediated colitis. Immune-mediated diarrhea or colitis have occurred. Permanently discontinue TECENTRIQ for Grade 4 diarrhea or colitis
• Immune-mediated endocrinopathies. Thyroid disorders, adrenal insufficiency, type 1 diabetes mellitus, including diabetic ketoacidosis, and hypophysitis/hypopituitarism have occurred
• Other immune-mediated adverse reactions. TECENTRIQ can cause severe and fatal immune-mediated adverse reactions. These immune-mediated reactions may involve any organ system. Permanently discontinue TECENTRIQ for Grade 4 immune-mediated adverse reactions involving a major organ
• Infections. Severe infections, including fatal cases, have occurred
• Infusion-related reactions. Severe or life-threatening infusion-related reactions have occurred. Permanently discontinue TECENTRIQ in patients with Grade 3 or 4 infusion-related reactions
• Embryo-fetal toxicity. TECENTRIQ can cause fetal harm in pregnant women. Verify pregnancy status prior to initiating TECENTRIQ. Advise females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TECENTRIQ and for at least 5 months after the last dose
• Advise female patients not to breastfeed while taking TECENTRIQ and for at least 5 months after the last dose
Most Common Adverse Reactions
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ in combination with other antineoplastic drugs for NSCLC and SCLC were fatigue/asthenia (49%), nausea (38%), alopecia (35%), constipation (29%), diarrhea (28%), and decreased appetite (27%).
You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1- 888-835-2555.
Please see full Prescribing Information for additional Important Safety Information.
1 of 3
for ® (atezolizumab)
Please see full Prescribing Information for additional Important Safety Information.
Upper Tract Urothelial Cancer
TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CM
C65.1 Malignant neoplasm of the right renal pelvis
C65.2 Malignant neoplasm of the left renal pelvis
C65.9 Malignant neoplasm of unspecified renal pelvis
C66.1 Malignant neoplasm of the right ureter
C66.2 Malignant neoplasm of the left ureter
C66.9 Malignant neoplasm of unspecified ureter
Drug: HCPCS J9022 Injection, atezolizumab, 10 mg
Drug: NDC
Note: Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference.
10-digit 11-digit
50242-917-01 50242-0917-01 1200 mg/20 mL single-dose vial
50242-918-01 50242-0918-01 840 mg/14 mL single-dose vial
Administration procedures: CPT
96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
CPT=Current Procedural Terminology; HCPCS=Healthcare Common Procedure Coding System; ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification; NDC=National Drug Code.
SAMPLE CODING
These codes are not all-inclusive; appropriate codes can vary by patient, setting of care and payer. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
Many payers will not accept unspecified codes. If you use an unspecified code, please check with your payer.
INDICATIONS & IMPORTANT SAFETY INFORMATIONINDICATIONSmUC
TECENTRIQ is indicated for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma who:
• Are not eligible for cisplatin-containing chemotherapy and whose tumors express PD-L1 (PD-L1–stained tumor-infiltrating immune cells [IC] covering ≥5% of the tumor area), as determined by an FDA-approved test, or
• Are not eligible for any platinum-containing chemotherapy regardless of PD-L1 status, or
• Have disease progression during or following any platinum-containing chemotherapy, or within 12 months of neoadjuvant or adjuvant chemotherapy
This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).
INDICATIONS (cont)NSCLC
TECENTRIQ, in combination with bevacizumab, paclitaxel, and carboplatin, is indicated for the first-line treatment of adult patients with metastatic non-squamous, non-small cell lung cancer (nsqNSCLC) with no EGFR or ALK genomic tumor aberrations.
TECENTRIQ, in combination with paclitaxel protein-bound and carboplatin, is indicated for the first-line treatment of adult patients with metastatic non-squamous NSCLC with no EGFR or ALK genomic tumor aberrations.
TECENTRIQ, as a single agent, is indicated for the treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) who have disease progression during or following platinum-containing chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for NSCLC harboring these aberrations prior to receiving TECENTRIQ.
mTNBC
TECENTRIQ, in combination with paclitaxel protein-bound, is indicated for the treatment of adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (TNBC) whose tumors express PD-L1 (PD-L1–stained tumor-infiltrating immune cells [IC] of any intensity covering ≥1% of the tumor area), as determined by an FDA-approved test.
This indication is approved under accelerated approval based on progression-free survival. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).
SCLC
TECENTRIQ, in combination with carboplatin and etoposide, is indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC).
IMPORTANT SAFETY INFORMATIONSerious Adverse Reactions
Please refer to the full Prescribing Information for important dose management information specific to adverse reactions.
• Immune-mediated pneumonitis. Immune-mediated pneumonitis or interstitial lung disease, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for Grade 3 or 4 pneumonitis
• Immune-mediated hepatitis. Immune-mediated hepatitis and liver test abnormalities, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for AST or ALT elevations more than 8 times the upper limit of normal or total bilirubin more than 3 times the upper limit of normal
• Immune-mediated colitis. Immune-mediated diarrhea or colitis have occurred. Permanently discontinue TECENTRIQ for Grade 4 diarrhea or colitis
• Immune-mediated endocrinopathies. Thyroid disorders, adrenal insufficiency, type 1 diabetes mellitus, including diabetic ketoacidosis, and hypophysitis/hypopituitarism have occurred
• Other immune-mediated adverse reactions. TECENTRIQ can cause severe and fatal immune-mediated adverse reactions. These immune-mediated reactions may involve any organ system. Permanently discontinue TECENTRIQ for Grade 4 immune-mediated adverse reactions involving a major organ
• Infections. Severe infections, including fatal cases, have occurred
• Infusion-related reactions. Severe or life-threatening infusion-related reactions have occurred. Permanently discontinue TECENTRIQ in patients with Grade 3 or 4 infusion-related reactions
• Embryo-fetal toxicity. TECENTRIQ can cause fetal harm in pregnant women. Verify pregnancy status prior to initiating TECENTRIQ. Advise females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TECENTRIQ and for at least 5 months after the last dose
• Advise female patients not to breastfeed while taking TECENTRIQ and for at least 5 months after the last dose
for ® (atezolizumab)
2 of 3Please see full Prescribing Information for additional Important Safety Information.
3 of 3
TECENTRIQ®, its logo and the Access Solutions logo are registered trademarks of Genentech, Inc.
© 2019 Genentech USA, Inc. So. San Francisco, CA All rights reserved. M-US-00001885(v1.0) 11/19
IMPORTANT SAFETY INFORMATION (cont)Most Common Adverse Reactions
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ alone were fatigue/asthenia (48%), decreased appetite (25%), nausea (24%), cough (22%), and dyspnea (22%).
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ in combination with other antineoplastic drugs for NSCLC and SCLC were fatigue/asthenia (49%), nausea (38%), alopecia (35%), constipation (29%), diarrhea (28%), and decreased appetite (27%).
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ with paclitaxel protein-bound for mTNBC were alopecia (56%), peripheral neuropathies (47%), fatigue (47%), nausea (46%), diarrhea (33%), anemia (28%), constipation (25%), cough (25%), headache (23%), neutropenia (21%), vomiting (20%), and decreased appetite (20%).
You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1- 888-835-2555.
Please see full Prescribing Information for additional Important Safety Information.
Please see full Prescribing Information for additional Important Safety Information.
for ® (atezolizumab)
1 of 3
for ® (atezolizumab)
Please see full Prescribing Information for additional Important Safety Information.
Lower Tract Urothelial Cancer
TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CM
C67.0 Malignant neoplasm of trigone of bladder
C67.1 Malignant neoplasm of dome of bladder
C67.2 Malignant neoplasm of lateral wall of bladder
C67.3 Malignant neoplasm of anterior wall of bladder
C67.4 Malignant neoplasm of posterior wall of bladder
C67.5 Malignant neoplasm of bladder neck
C67.6 Malignant neoplasm of ureteric orifice
C67.7 Malignant neoplasm of urachus
C67.8 Malignant neoplasm of overlapping sites of bladder
C67.9 Malignant neoplasm of bladder, unspecified
C68.0 Malignant neoplasm of the urethra
Drug: HCPCS J9022 Injection, atezolizumab, 10 mg
Drug: NDC
Note: Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference.
10-digit 11-digit
50242-917-01 50242-0917-01 1200 mg/20 mL single-dose vial
50242-918-01 50242-0918-01 840 mg/14 mL single-dose vial
Administration procedures: CPT
96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
CPT=Current Procedural Terminology; HCPCS=Healthcare Common Procedure Coding System; ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification; NDC=National Drug Code.
SAMPLE CODING
These codes are not all-inclusive; appropriate codes can vary by patient, setting of care and payer. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
Many payers will not accept unspecified codes. If you use an unspecified code, please check with your payer.
INDICATIONS & IMPORTANT SAFETY INFORMATIONINDICATIONSmUC
TECENTRIQ is indicated for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma who:
• Are not eligible for cisplatin-containing chemotherapy and whose tumors express PD-L1 (PD-L1–stained tumor-infiltrating immune cells [IC] covering ≥5% of the tumor area), as determined by an FDA-approved test, or
• Are not eligible for any platinum-containing chemotherapy regardless of PD-L1 status, or
• Have disease progression during or following any platinum-containing chemotherapy, or within 12 months of neoadjuvant or adjuvant chemotherapy
This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).
NSCLC
TECENTRIQ, in combination with bevacizumab, paclitaxel, and carboplatin, is indicated for the first-line treatment of adult patients with metastatic non-squamous, non-small cell lung cancer (nsqNSCLC) with no EGFR or ALK genomic tumor aberrations.
TECENTRIQ, in combination with paclitaxel protein-bound and carboplatin, is indicated for the first-line treatment of adult patients with metastatic non-squamous NSCLC with no EGFR or ALK genomic tumor aberrations.
TECENTRIQ, as a single agent, is indicated for the treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) who have disease progression during or following platinum-containing chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for NSCLC harboring these aberrations prior to receiving TECENTRIQ.
mTNBC
TECENTRIQ, in combination with paclitaxel protein-bound, is indicated for the treatment of adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (TNBC) whose tumors express PD-L1 (PD-L1–stained tumor-infiltrating immune cells [IC] of any intensity covering ≥1% of the tumor area), as determined by an FDA-approved test.
This indication is approved under accelerated approval based on progression-free survival. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).
SCLC
TECENTRIQ, in combination with carboplatin and etoposide, is indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC).
IMPORTANT SAFETY INFORMATIONSerious Adverse Reactions
Please refer to the full Prescribing Information for important dose management information specific to adverse reactions.
• Immune-mediated pneumonitis. Immune-mediated pneumonitis or interstitial lung disease, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for Grade 3 or 4 pneumonitis
• Immune-mediated hepatitis. Immune-mediated hepatitis and liver test abnormalities, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for AST or ALT elevations more than 8 times the upper limit of normal or total bilirubin more than 3 times the upper limit of normal
• Immune-mediated colitis. Immune-mediated diarrhea or colitis have occurred. Permanently discontinue TECENTRIQ for Grade 4 diarrhea or colitis
• Immune-mediated endocrinopathies. Thyroid disorders, adrenal insufficiency, type 1 diabetes mellitus, including diabetic ketoacidosis, and hypophysitis/hypopituitarism have occurred
• Other immune-mediated adverse reactions. TECENTRIQ can cause severe and fatal immune-mediated adverse reactions. These immune-mediated reactions may involve any organ system. Permanently discontinue TECENTRIQ for Grade 4 immune-mediated adverse reactions involving a major organ
• Infections. Severe infections, including fatal cases, have occurred
• Infusion-related reactions. Severe or life-threatening infusion-related reactions have occurred. Permanently discontinue TECENTRIQ in patients with Grade 3 or 4 infusion-related reactions
for ® (atezolizumab)
2 of 3Please see full Prescribing Information for additional Important Safety Information.
3 of 3
TECENTRIQ®, its logo and the Access Solutions logo are registered trademarks of Genentech, Inc.
© 2019 Genentech USA, Inc. So. San Francisco, CA All rights reserved. M-US-00001885(v1.0) 11/19
IMPORTANT SAFETY INFORMATION (cont)Serious Adverse Reactions (cont)
• Embryo-fetal toxicity. TECENTRIQ can cause fetal harm in pregnant women. Verify pregnancy status prior to initiating TECENTRIQ. Advise females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TECENTRIQ and for at least 5 months after the last dose
• Advise female patients not to breastfeed while taking TECENTRIQ and for at least 5 months after the last dose
Most Common Adverse Reactions
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ alone were fatigue/asthenia (48%), decreased appetite (25%), nausea (24%), cough (22%), and dyspnea (22%).
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ in combination with other antineoplastic drugs for NSCLC and SCLC were fatigue/asthenia (49%), nausea (38%), alopecia (35%), constipation (29%), diarrhea (28%), and decreased appetite (27%).
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ with paclitaxel protein-bound for mTNBC were alopecia (56%), peripheral neuropathies (47%), fatigue (47%), nausea (46%), diarrhea (33%), anemia (28%), constipation (25%), cough (25%), headache (23%), neutropenia (21%), vomiting (20%), and decreased appetite (20%).
You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1- 888-835-2555.
Please see full Prescribing Information for additional Important Safety Information.
Please see full Prescribing Information for additional Important Safety Information.
for ® (atezolizumab)
1 of 2
for ® (atezolizumab)
Please see full Prescribing Information for additional Important Safety Information.
Hepatocellular Carcinoma (HCC)
TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CMC22.0 Liver cell carcinoma, hepatocellular carcinoma
C22.8 Malignant neoplasm of liver, primary, unspecified as to type
Drug: HCPCS J9022 Injection, atezolizumab, 10 mg
Drug: NDC
Note: Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference.
10-digit 11-digit
50242-917-01 50242-0917-01 1200 mg/20 mL single-dose vial
50242-918-01 50242-0918-01 840 mg/14 mL single-dose vial
Administration procedures: CPT
96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
96417
Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)
CPT=Current Procedural Terminology; HCPCS=Healthcare Common Procedure Coding System; ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification; NDC=National Drug Code.
SAMPLE CODING
These codes are not all-inclusive; appropriate codes can vary by patient, setting of care and payer. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
Many payers will not accept unspecified codes. If you use an unspecified code, please check with your payer.
INDICATIONS & IMPORTANT SAFETY INFORMATIONINDICATIONSHCC
TECENTRIQ, in combination with bevacizumab, is indicated for the treatment of patients with unresectable or metastatic hepatocellular carcinoma (HCC) who have not received prior systemic therapy.
IMPORTANT SAFETY INFORMATIONSerious Adverse Reactions
Please refer to the full Prescribing Information for important dose management information specific to adverse reactions.
• Immune-mediated pneumonitis. Immune-mediated pneumonitis or interstitial lung disease, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for Grade 3 or 4 pneumonitis
for ® (atezolizumab)
IMPORTANT SAFETY INFORMATION (cont)• Immune-mediated hepatitis. Immune-mediated hepatitis and liver test abnormalities, including fatal cases, have occurred. Permanently
discontinue TECENTRIQ for AST or ALT elevations more than 8 times the upper limit of normal or total bilirubin more than 3 times the upper limit of normal
• Immune-mediated colitis. Immune-mediated diarrhea or colitis have occurred. Permanently discontinue TECENTRIQ for Grade 4 diarrhea or colitis
• Immune-mediated endocrinopathies. Thyroid disorders, adrenal insufficiency, type 1 diabetes mellitus, including diabetic ketoacidosis, and hypophysitis/hypopituitarism have occurred
• Other immune-mediated adverse reactions. TECENTRIQ can cause severe and fatal immune-mediated adverse reactions. These immune-mediated reactions may involve any organ system. Permanently discontinue TECENTRIQ for Grade 4 immune-mediated adverse reactions involving a major organ
• Infections. Severe infections, including fatal cases, have occurred
• Infusion-related reactions. Severe or life-threatening infusion-related reactions have occurred. Permanently discontinue TECENTRIQ in patients with Grade 3 or 4 infusion-related reactions
• Embryo-fetal toxicity. TECENTRIQ can cause fetal harm in pregnant women. Verify pregnancy status prior to initiating TECENTRIQ. Advise females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TECENTRIQ and for at least 5 months after the last dose
• Advise female patients not to breastfeed while taking TECENTRIQ and for at least 5 months after the last dose
Most Common Adverse Reactions
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ in combination with bevacizumab for HCC were hypertension (30%), fatigue/asthenia (26%), and proteinuria (20%).
You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1- 888-835-2555.
Please see full Prescribing Information for additional Important Safety Information.
2 of 2
TECENTRIQ®, its logo and the Access Solutions logo are registered trademarks of Genentech, Inc.
© 2020 Genentech USA, Inc. So. San Francisco, CA All rights reserved. M-US-00004118(v1.0) 06/20
Please see full Prescribing Information for additional Important Safety Information.
1 of 2
for ® (atezolizumab)
Please see full Prescribing Information for additional Important Safety Information.
Malignant Melanoma
TYPE CODE DESCRIPTION
Diagnosis: ICD-10-CM C43.0*–C43.9 Malignant melanoma of skin, by site
Drug: HCPCS J9022 Injection, atezolizumab, 10 mg
Drug: NDC
Note: Payer requirements regarding use of a 10-digit or 11-digit NDC may vary. Both formats are listed here for your reference.
10-digit 11-digit
50242-917-01 50242-0917-01 1200 mg/20 mL single-dose vial
50242-918-01 50242-0918-01 840 mg/14 mL single-dose vial
Administration procedures: CPT
96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
96417
Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)
SAMPLE CODING
CPT=Current Procedural Terminology; HCPCS=Healthcare Common Procedure Coding System; ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification; NDC=National Drug Code.
* This range of codes does not include melanoma in situ (D03.-), malignant melanoma of the skin of genital organs (C51–52, C60.-, C63.2), Merkel cell carcinoma (C4A.-), vermillion border of the lip (C00.0–C00.2), malignant neoplasm of the anus (C21.0), malignant neoplasm of scrotum (C63.2); plus, for melanoma of sites other than the skin (not previously specified), code to the malignant neoplasm of that site.
These codes are not all-inclusive; appropriate codes can vary by patient, setting of care and payer. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
Many payers will not accept unspecified codes. If you use an unspecified code, please check with your payer.
INDICATIONS & IMPORTANT SAFETY INFORMATIONINDICATIONSMelanoma
TECENTRIQ, in combination with cobimetinib and vemurafenib, is indicated for the treatment of patients with BRAF V600 mutation-positive unresectable or metastatic melanoma.
IMPORTANT SAFETY INFORMATIONSerious Adverse Reactions
Please refer to the full Prescribing Information for important dose management information specific to adverse reactions.
• Immune-mediated pneumonitis. Immune-mediated pneumonitis or interstitial lung disease, including fatal cases, have occurred. Permanently discontinue TECENTRIQ for Grade 3 or 4 pneumonitis
for ® (atezolizumab)
IMPORTANT SAFETY INFORMATION (cont)• Immune-mediated hepatitis. Immune-mediated hepatitis and liver test abnormalities, including fatal cases, have occurred. Permanently
discontinue TECENTRIQ for AST or ALT elevations more than 8 times the upper limit of normal or total bilirubin more than 3 times the upper limit of normal
• Immune-mediated colitis. Immune-mediated diarrhea or colitis have occurred. Permanently discontinue TECENTRIQ for Grade 4 diarrhea or colitis
• Immune-mediated endocrinopathies. Thyroid disorders, adrenal insufficiency, type 1 diabetes mellitus, including diabetic ketoacidosis, and hypophysitis/hypopituitarism have occurred
• Other immune-mediated adverse reactions. TECENTRIQ can cause severe and fatal immune-mediated adverse reactions. These immune-mediated reactions may involve any organ system. Permanently discontinue TECENTRIQ for Grade 4 immune-mediated adverse reactions involving a major organ
• Infections. Severe infections, including fatal cases, have occurred
• Infusion-related reactions. Severe or life-threatening infusion-related reactions have occurred. Permanently discontinue TECENTRIQ in patients with Grade 3 or 4 infusion-related reactions
• Embryo-fetal toxicity. TECENTRIQ can cause fetal harm in pregnant women. Verify pregnancy status prior to initiating TECENTRIQ. Advise females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TECENTRIQ and for at least 5 months after the last dose
• Advise female patients not to breastfeed while taking TECENTRIQ and for at least 5 months after the last dose
Most Common Adverse Reactions
The most common adverse reactions (rate ≥20%) in patients who received TECENTRIQ in combination with cobimetinib and vemurafenib for melanoma were rash (75%), musculoskeletal pain (62%), fatigue (51%), hepatotoxicity (50%), pyrexia (49%), nausea (30%), pruritus (26%), edema (26%), stomatitis (23%), hypothyroidism (22%), and photosensitivity reaction (21%).
You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.
Please see full Prescribing Information for additional Important Safety Information.
2 of 2
TECENTRIQ® and the Access Solutions logo are registered trademarks of Genentech, Inc.
© 2020 Genentech USA, Inc. So. San Francisco, CA All rights reserved. M-US-00006394(v1.0) 07/20
Please see full Prescribing Information for additional Important Safety Information.