Local Coverage Article: Kyprolis (Carfilzomib) Coding and Billing Guidelines and Indications (A53779)

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1 Local Coverage Article: Kyprolis (Carfilzomib) Coding and Billing Guidelines and Indications (A53779) Contractor Information Contractor Name Palmetto GBA Article Information General Information Article ID A53779 Original ICD-9 Article ID A53404 Article Title Kyprolis (Carfilzomib) Coding and Billing Guidelines and Indications AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT only copyright American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS 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. The Code on Dental Procedures and Nomenclature (Code) is published in Current Original Effective Date 10/01/2015 Revision Effective Date 10/01/2015 Revision Ending Date Retirement Date

2 Dental Terminology (CDT). Copyright American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association. UB-04 Manual. OFFICIAL UB-04 DATA SPECIFICATIONS MANUAL, 2014, is copyrighted by American Hospital Association ( AHA ), Chicago, Illinois. No portion of OFFICIAL UB-04 MANUAL may be reproduced, sorted in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior express, written consent of AHA. Health Forum reserves the right to change the copyright notice from time to time upon written notice to Company. Article Guidance Article Text: Effective July 20, 2012, Kyprolis (Carfilzomib) was approved by the Food and Drug Administration (FDA) for the treatment of multiple myeloma. Kyprolis is approved only for multiple myeloma at this time. The patient must first have received two prior therapies including bortezomib (Velcade ) and an immunomodulatory agent and must have shown disease progression within 60 days of completion of the last treatment regimen. Kyprolis is administered intravenously over 2 to 10 minutes, on two consecutive days, each week for three weeks (Days 1, 2, 8, 9, 15 and 16), followed by a 12-day rest period (Days 17 to 28). Each 28-day period is considered one treatment cycle. In Cycle 1, Kyprolis is administered at a dose of 20 mg/m2/day. If tolerated in Cycle 1, the dose should be escalated to 27 mg/m2/day beginning in Cycle 2 and continued at 27 mg/m2/day in subsequent cycles. Treatment may be continued until disease progression or until unacceptable toxicity occurs. Documentation must include verification of the administration of dexamethasone 4 mg orally or intravenously prior to all doses of Kyprolis during Cycle 1, during the first cycle of dose escalation to 27 mg/m2/day and if infusion reaction symptoms develop or reappear (to reduce the incidence and severity of infusion reactions).

3 For Medicare Billing: Hospital The ICD-10-CM diagnosis code required for billing Kyprolis is: o C90.00 Multiple myeloma o C90.02 Multiple myeloma in relapse Effective January 1, 2014, the HCPCS code for billing is J9047. The documented dose administered Physician The ICD-10-CM diagnosis code required for billing Kyprolis is: o C90.00 Multiple myeloma o C90.02 Multiple myeloma in relapse HCPCS code J9047 (Injection, carfilzomib 1 mg) Narrative must state the name of the two drugs given prior to using Kyprolis and state 'patient shows disease progression' and the dose administered Coding Information Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims. Revenue Codes: Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the article services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. CPT/HCPCS Codes Group 1 Paragraph: For Part A and Part B Effective January 1, 2014, the HCPCS code for billing is J9047.

4 Group 1 Codes: CPT/HCPCS Codes Information Table J9047 INJECTION, CARFILZOMIB, 1 MG ICD-10 Codes that are Covered Group 1 Paragraph: For Part A and Part B Group 1Codes ICD-10 Code Description C90.00 Multiple myeloma not having achieved remission C90.02 Multiple myeloma in relapse Showing 1 to 2 of 2 entries in Group 1 ICD-10 Codes that are Not Covered Revision History Information Please note: The Revision History information included in this Article prior to 06/20/2013 will now display with a Revision History Number of "R1" at the bottom of this table. All new Revision History information entries completed on or after 06/20/2013 will display as a row in the Revision History section of the Article and numbering will begin with "R2". Revision History Date 10/01/2015 R5 10/01/2015 R4 06/11/2015 R3 Revision History Number Revision History Explanation Under Article Title and throughout the article added the registered trademark for Kyprolis. Under Article Text-For Medicare Billing deleted the second bullet regarding revenue codes to utilize for billing Kyprolis. Per CMS Internet-Only Manual, Pub , Medicare Program Integrity Manual, Chapter 13, LCDs consist of only reasonable and necessary information. All bill type and revenue codes have been removed from the LCDs. For consistency, they are also being removed from the articles. Added part A contract coverage. Corrected ICD-10 coding in Article Text. Per CMS Internet-Only Manual, Pub , Medicare Program Integrity Manual, Chapter 13, LCDs consist of only reasonable and necessary information. All bill type and revenue

5 05/21/2015 R2 10/01/2015 R1 codes have been removed from the LCDs. For consistency, they are also being removed from the articles. Under Article Text corrected the dosing instructions in the 4th paragraph to read 20 mg/m2/day and 27 mg/m2/day. Re-worded the 5th paragraph to read "...during the first cycle of dose escalation to 27 mg/m2/day and if infusion reaction symptoms develop or reappear (to reduce the incidence and severity of infusion reactions)." Removed the statement "*For services billed January 1, December 31, 2013, the HCPCS code for billing is C9295" as this time frame will be invalid for timely billing upon activation of this ICD-10 policy. Added Contractor numbers for Part B making this an A/B MAC article. Associated Documents Related Local Coverage Document(s) Related National Coverage Document(s) Statutory Requirements URL(s) Rules and Regulations URL(s) CMS Manual Explanations URL(s) Other URL(s) Public Version(s) Updated on 06/17/2015 with effective dates 10/01/ Updated on 06/16/2015 with effective dates 10/01/ Updated on 06/02/2015 with effective dates 10/01/ Updated on 05/12/2015 with effective dates 10/01/ Updated on 10/21/2014 with effective dates 10/01/ Keywords Kyprolis Carfilzomib Read the Article Disclaimer

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