Effective with date of service April 21, 2023, NC Medicaid covers paclitaxel protein-bound particles for injectable suspension, (albumin-bound), for intravenous use (HBT Labs) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
Strength/Package Size: For injectable suspension: white to yellow, sterile, lyophilized powder containing 100 mg of paclitaxel formulated as albumin bound particles in single-dose vial for reconstitution.
Indicated for the treatment of:
- Metastatic breast cancer, after failure of combination chemotherapy for metastatic disease or relapse within 6 months of adjuvant chemotherapy. Prior therapy should have included an anthracycline unless clinically contraindicated.
- Locally advanced or metastatic non-small cell lung cancer (NSCLC), as first-line treatment in combination with carboplatin, in patients who are not candidates for curative surgery or radiation therapy.
- Metastatic adenocarcinoma of the pancreas as first-line treatment, in combination with gemcitabine.
Recommended Dose:
- Metastatic Breast Cancer (MBC): 260 mg/m² intravenously over 30 minutes every 3 weeks.
- Non-Small Cell Lung Cancer (NSCLC): 100 mg/m² intravenously over 30 minutes on Days 1, 8, and 15 of each 21-day cycle; administer carboplatin on Day 1 of each 21-day cycle immediately after Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound).
- Adenocarcinoma of the Pancreas: 125 mg/m² intravenously over 30-40 minutes on Days 1, 8 and 15 of each 28-day cycle; administer gemcitabine on Days 1, 8 and 15 of each 28-day cycle immediately after Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound).
See full prescribing information for further detail.
For Medicaid Billing
- The ICD-10-CM diagnosis codes required for billing are:
- Metastatic adenocarcinoma of the pancreas:
- C25.0 - Malignant neoplasm of head of pancreas
- C25.1 - Malignant neoplasm of body of pancreas;
- C25.2 - Malignant neoplasm of tail of pancreas;
- C25.3 - Malignant neoplasm of pancreatic duct;
- C25.4 - Malignant neoplasm of endocrine pancreas;
- C25.7 - Malignant neoplasm of other parts of pancreas;
- C25.8 - Malignant neoplasm of overlapping sites of pancreas;
- Locally advanced or metastatic NSCLC:
- C33 - Malignant neoplasm of trachea;
- C34.01 - Malignant neoplasm of right main bronchus;
- C34.02 - Malignant neoplasm of left main bronchus;
- C34.11 - Malignant neoplasm of upper lobe, right bronchus or lung;
- C34.12 - Malignant neoplasm of upper lobe, left bronchus or lung;
- C34.2 - Malignant neoplasm of middle lobe, bronchus or lung;
- C34.31 - Malignant neoplasm of lower lobe, right bronchus or lung;
- C34.32 - Malignant neoplasm of lower lobe, left bronchus or lung;
- C34.81 - Malignant neoplasm of overlapping sites of right bronchus and lung;
- C34.82 - Malignant neoplasm of overlapping sites of left bronchus and lung;
- C34.91 - Malignant neoplasm of unspecified part of right bronchus or lung;
- C34.92 - Malignant neoplasm of unspecified part of left bronchus or lung;
- Metastatic breast cancer:
- C50.011 - Malignant neoplasm of nipple and areola, right female breast;
- C50.012 - Malignant neoplasm of nipple and areola, left female breast;
- C50.021 - Malignant neoplasm of nipple and areola, right male breast;
- C50.022 - Malignant neoplasm of nipple and areola, left male breast;
- C50.111 - Malignant neoplasm of central portion of right female breast;
- C50.112 - Malignant neoplasm of central portion of left female breast;
- C50.121 - Malignant neoplasm of central portion of right male breast;
- C50.122 - Malignant neoplasm of central portion of left male breast;
- C50.211 - Malignant neoplasm of upper-inner quadrant of right female breast;
- C50.212 - Malignant neoplasm of upper-inner quadrant of left female breast;
- C50.221 - Malignant neoplasm of upper-inner quadrant of right male breast;
- C50.222 - Malignant neoplasm of upper-inner quadrant of left male breast;
- C50.311 - Malignant neoplasm of lower-inner quadrant of right female breast;
- C50.312 - Malignant neoplasm of lower-inner quadrant of left female breast;
- C50.321 - Malignant neoplasm of lower-inner quadrant of right male breast;
- C50.322 - Malignant neoplasm of lower-inner quadrant of left male breast;
- C50.411 - Malignant neoplasm of upper-outer quadrant of right female breast;
- C50.412 - Malignant neoplasm of upper-outer quadrant of left female breast;
- C50.421 - Malignant neoplasm of upper-outer quadrant of right male breast;
- C50.422 - Malignant neoplasm of upper-outer quadrant of left male breast;
- C50.511 - Malignant neoplasm of lower-outer quadrant of right female breast;
- C50.512 - Malignant neoplasm of lower-outer quadrant of left female breast;
- C50.521 - Malignant neoplasm of lower-outer quadrant of right male breast;
- C50.522 - Malignant neoplasm of lower-outer quadrant of left male breast;
- C50.611 - Malignant neoplasm of axillary tail of right female breast;
- C50.612 - Malignant neoplasm of axillary tail of left female breast;
- C50.621 - Malignant neoplasm of axillary tail of right male breast;
- C50.622 - Malignant neoplasm of axillary tail of left male breast;
- C50.811 - Malignant neoplasm of overlapping sites of right female breast;
- C50.812 - Malignant neoplasm of overlapping sites of left female breast;
- C50.821 - Malignant neoplasm of overlapping sites of right male breast;
- C50.822 - Malignant neoplasm of overlapping sites of left male breast
- Metastatic adenocarcinoma of the pancreas:
- Providers must bill with HCPCS code: J9999 - Not otherwise classified, antineoplastic drugs
- One Medicaid unit of coverage is: 1 mg
- The maximum reimbursement rate per unit is: $17.01342
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDC is: 00517-4300-01
- The NDC units should be reported as "UN1."
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update and 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 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 the NC Medicaid Fee Schedule & Covered Code portal.
Contact
NCTracks Call Center: 800-688-6696