Halaven - Permanent J Code

posted December 16, 2011

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Announcing the permanent J-code J9179 for Halaven^® (eribulin mesylate) Injection

Effective January 1, 2012, the Centers for Medicare & Medicaid Services (CMS) has assigned a permanent Healthcare Common Procedure Coding System (HCPCS) J-code for Halaven. This new code will replace both the temporary C-code used in the hospital outpatient setting as well as the miscellaneous HCPCS codes used in other settings, including J9999 and J3490.

J9179 can be used with all Medicare/Medicaid claims and most private commercial payors (coding requirements may vary).  

Because Halaven has been issued a billing unit of 0.1 mg by CMS, providers wishing to bill for one single dose 1 mg/ 2 mL vial of Halaven may bill 10 units.  Billing units can be reported in box 24G on the CMS-1500 claim form for physician offices and box 46 on the CMS-1450 (UB-04) claim form for the hospital outpatient department.  J9179 can be reported in box 24D on the CMS-1500 claim form for physician offices and box 44 on the CMS-1450 (UB-04) claim form for the hospital outpatient department.

For more information, contact the Eisai Assistance Program (EAP) for Halaven at:
PO Box 29231
Phoenix, AZ 8508
Phone: 1-866-61-EISAI (1-866-613-4724)
Fax: 1-866-573-4724
Monday - Friday, 8:00 AM to 8:00 PM, ET
Or visit www.halavenreimbursement.com

Eisai cannot guarantee payment of any claim. Coding, coverage, and reimbursement may vary significantly by payor, plan, patient, and setting of care. Actual coverage and reimbursement decisions are made by individual payors following the receipt of claims. For additional information, customers should consult with their payors for all relevant coding, reimbursement, and coverage requirements. It is the sole responsibility of the provider to select the proper code and ensure the accuracy of all claims used in seeking reimbursement. All services must be medically appropriate and properly supported in the patient medical record.

HALAVEN^® is a registered trademark used by Eisai Inc. under license from Eisai R&D Management Co., Ltd.
© 2011 Eisai Inc. All rights reserved. December 2011 ERI 298