ICD-10 Codes
- Access and Reimbursement GuideA comprehensive summary of important medication information including uses, Important Safety Information, access, and reimbursement.
- Benefits Investigation FormA way to find out if TECVAYLI® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies.
- Business Associate AgreementComplete a Business Associate Agreement for your practice only once. No individual patient authorizations are required.
- Coding and Billing Guide
- Exception Considerations ChecklistA guide to submitting a formulary exception request.
Exception Considerations Checklist (en español) - Exception Considerations Checklist (en español)A guide to submitting a formulary exception request.
- FDA Approval Letter for TECVAYLI®
- Janssen CarePath Resource GuideA comprehensive summary of support tools for your office to help patients start and stay on treatment.
- Letter of Medical Necessity and ExceptionA template that you can fill out and submit to a patient’s health insurance provider. You may use it to explain why TECVAYLI® is medically necessary for your patient or to request a formulary exception.
- Patient Account Overview
- Patient Affordability OptionsDiscover options that can make TECVAYLI® more affordable for your patients.
- Patient Authorization FormIndividual patient form for offices without a Business Associate Agreement.
Patient Authorization Form (en español) - Patient Authorization Form (en español)Individual patient form for offices without a Business Associate Agreement.
- Prior Authorization Considerations ChecklistA checklist to guide you through the prior authorization process.
Prior Authorization Considerations Checklist (en español) - Prior Authorization Considerations Checklist (en español)A checklist to guide you through the prior authorization process.
- Savings Program (Overview)Eligible patients using commercial or private insurance can save on out-of-pocket costs for TECVAYLI®.
- Savings Program Assignment of Benefits FormA form the patient can submit that allows Janssen CarePath to reimburse the provider directly.
- Savings Program Rebate FormA form the patient can submit if the pharmacy is not able to process the Janssen CarePath Savings Program card.
- Savings Program – Submitting Medical ClaimsA guide on submitting medical benefit rebate claims for TECVAYLI®.
- Specialty Distributors for TECVAYLI® FlashcardInformation about Specialty Distributors for TECVAYLI®.
- Verification of Benefits Guide (Medical)A guide to understanding the Verification of Benefits for your patient’s medical benefits.
- Verification of Benefits Guide (Pharmacy)A guide to understanding the Verification of Benefits for your patient’s pharmacy benefits.
ICD-10 Codes
C90.0 Multiple Myeloma
TIP: Do not assign an additional code for bone metastasis (C79.51) when multiple myeloma is described as metastatic to the bone; bone involvement is integral to this disease process.
ICD-10 Indication | ICD-10 Code |
Multiple myeloma not having achieved remission | C90.00 |
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Multiple myeloma in remission | C90.01 |
Multiple myeloma in relapse | C90.02 |
Collected in 10/21 and may change.
This information is not a promise of coverage or payment. It is not intended to give reimbursement advice or increase reimbursement by any payer. Legal requirements and plan information can be updated frequently. Contact the plan for more information about current coverage, reimbursement policies, restrictions, or requirements that may apply.
For more information on ICD-10, visit the CMS website.
SOURCE
ICD-10-CM 2022: The Complete Official Codebook. American Medical Association, 2021.