National Drug Code (NDC) for Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)

The NDC for Paclitaxel Protein-Bound Particles is often required in addition to the appropriate J Code when filing a claim for reimbursement.

Providers should check with their local payers to determine whether reporting requires the 10-digit vs 11-digit NDC. Please see below:

NDCs may not be required for drugs with a product-specific HCPCS code under traditional Medicare, but must be included for drugs that are billed using a “miscellaneous” HCPCS code, such as C9399 or J9999, as part of the additional information that is reported on claims. Medicare Advantage plans may have different NDC reporting policies from traditional Medicare.

Providers should always check with their local payers to determine NDC reporting requirements.

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Healthcare Common Procedure Coding System (HCPCS) and Revenue Codes for Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)

HCPCS codes are used for billing drugs and services to Medicare, Medicaid, and commercial payers. Effective July 1, 2023, the Centers for Medicare and Medicaid Services (CMS) established a new product-specific HCPCS code for Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound).

It is important to note that if less than the entire vial of Paclitaxel Protein-Bound Particles is administered, the remainder must be discarded. Current CMS policy for outpatient or office administered drugs permits billing for the entire vial even if the entire contents are not used—but only if the unused portion is discarded and it is appropriately documented. The discarded amount is billed on a second claim line with a “JW” modifier.¹

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Current Procedural Terminology (CPT*) Codes for Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)

CPT codes are used to indicate which medical services and procedures were performed on a patient and/or how a drug or medical supply was administered. The following CPT codes may be used for administering Paclitaxel Protein-Bound Particles:

International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) Diagnosis Codes

ICD-10-CM diagnosis codes are used to identify a patient’s diagnosis and inform payers of why a service was provided.

ICD-10-CM is a seven-character, alphanumeric code. Each code begins with a letter, and that letter is followed by two numbers. The first three characters of ICD-10-CM are the “category.” The category describes the general type of the injury or disease. The category is followed by a decimal point and the subcategory. This is followed by up to two subclassifications, which further explain the cause, manifestation, location, severity, and type of injury or disease. The last character is the extension. The extension describes the type of encounter. That is, if this is the first time a healthcare provider has seen the patient for this condition/injury/disease, it’s listed as the “initial encounter.” Every encounter after the first is listed as a “subsequent encounter.” Patient visits related to the effects of a previous injury or disease are listed with the term “sequela.”

For a full ist of the ICD-10-CM diagnosis codes for the labeled indications for Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound), download the Billing and Coding Guide.