Tafasitamab-cxix for Injection, for Intravenous Use (Monjuvi®) HCPCS Code J9999: Billing Guidelines

Effective with date of service Aug. 13, 2020, the Medicaid and NC Health Choice programs cover tafasitamab-cxix for injection, for intravenous use (Monjuvi®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Strength/Package Size: For injection: 200 mg of tafasitamab-cxix as lyophilized powder in single-dose vial for reconstitution.

Indicated in combination with lenalidomide for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not otherwise specified, including DLBCL arising from low grade lymphoma and who are not eligible for autologous stem cell transplant (ASCT).

Recommended Dose: The recommended dosage of Monjuvi® is 12 mg/kg based on actual body weight as an intravenous infusion according to the following dosing schedule: 

- Cycle 1: Days 1, 4, 8, 15 and 22 of the 28-day cycle
- Cycles 2 and 3: Days 1, 8, 15 and 22 of each 28-day cycle
- Cycle 4 and beyond: Days 1 and 15 of each 28-day cycle

See full prescribing information for further detail.

For Medicaid and NC Health Choice Billing

• The ICD-10-CM diagnosis codes required for billing is/are: 

• Providers must bill with HCPCS code: J9999 - Not otherwise classified, antineoplastic drugs
• One Medicaid and NC Health Choice unit of coverage is: 1 mg 
• The maximum reimbursement rate per unit is: $6.48
• Providers must bill 11-digit NDCs and appropriate NDC units. The NDC is: 73535-0208-01
• The NDC units should be reported as “UN1”
• For additional information, refer to the January 2012 Special Bulletin National Drug Code Implementation Update
• For additional information regarding NDC claim requirements related to the PADP, refer to the PADP Clinical Coverage Policy 1B, Attachment A, H.7 on Medicaid's website
• Providers shall bill their usual and customary charge for non-340B drugs
• PADP reimburses for drugs billed for Medicaid and Health Choice beneficiaries by 340B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is reflective of their acquisition cost. Providers shall indicate that a drug was purchased under a 340B purchasing agreement by appending the “UD” modifier on the drug detail.
• The fee schedule for the PADP is available on Medicaid's PADP web page

Contact

NCTracks Contact Center: 800-688-6696