Coding Quick Reference Guide for HES

Code Type Code Description
HCPCS (Healthcare Common Procedure Coding System)
Injection, mepolizumab, 1 mg
NDC (National Drug Code) 0173-0881-01
100 mg/mL mepolizumab in 1-mL single-dose vial, which contains lyophilized powder for subcutaneous injection
0173-0892-01 100 mg/mL mepolizumab in 1-mL single-dose prefilled autoinjector, which contains solution for subcutaneous injection
0173-0892-42 100 mg/mL mepolizumab in 1-mL single-dose prefilled syringe, which contains solution for subcutaneous injection
96372 Therapeutic, prophylactic, or diagnostic injection (specialty substance or drug); subcutaneous or intramuscular
96401 Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic

*Payer requirements regarding use of the 10- or 11-digit NDC vary. Check payer requirements for appropriate reporting of the NDC.

The American Medical Association (AMA) has recognized the use of the 96401 administration code for some non-chemotherapy substances, such as certain monoclonal antibody agents and other biologic response modifiers. Since NUCALA is a human monoclonal antibody agent, this CPT code may be applicable. However, criteria for coverage for chemotherapy administration codes for non-chemotherapy drugs do vary by payer. Consult the payer for appropriate documentation in order to support the use of these codes.

CPT=Current Procedural Terminology; CPT is a registered trademark of the American Medical Association.

The coding, coverage, reimbursement, and related information presented in this guide is from various third-party sources and is subject to change without notice. GlaxoSmithKline (GSK) cannot guarantee the accuracy or timeliness of these data. It should not be considered a guarantee of success of obtaining third-party insurance payment for any product and should not be relied upon without confirmation. The decision by a payer to pay for a specific product is based on many factors. It is always the prescriber’s responsibility to determine the appropriate treatment and submit appropriate codes, charges, and modifiers for treatments provided. Providers should contact third-party payers for specific information on their policies.