Quick Reference Guide - Reimbursement - Fludara® (fludarabine phosphate) for injection

All third-party payers require that the patient's diagnosis be listed on the claim form to determine medical necessity and appropriateness of the treatment billed. The appropriate diagnosis code (ICD-9-CM code) for FLUDARA® (fludarabine phosphate) FOR INJECTION when used to treat refractory B-cell chronic lymphocytic leukemia is:

Diagnosis Code:

204.10 (Chronic lymphocytic leukemia, without mention of remission)

Medicare, Medicaid, and many other payers use the HCFA Common Procedure Coding System (HCPCS for outpatient services. HCPCS is composed of CPT codes and alphanumeric codes.

Alphanumeric Code:	J9185 (fludarabine phosphate, 50 mg) Specify actual dosage administered on claim form
CPT Code:	96410 (Chemotherapy administration, intravenous infusion technique, up to one hour)

To avoid delayed payment or denied claims:

Provide all information requested on claim forms
Be sure that you and your Medicare Part B patient have signed the HCFA-1500 claim form or that an assignment of benefits is on file
Use proper codes