NATIONAL DRUG CODE (NDC) AND BILLING AND DIAGNOSIS CODES FOR KEYTRUDA

The following codes may be relevant when billing for KEYTRUDA and its administration. This information is current as of November 2018. The information provided here is compiled from sources believed to be accurate, but Merck makes no representation that it is accurate. Information about HCPCS codes is based on guidance issued by the CMS applicable to Medicare Part B and may not apply to other public or private payers. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of its use and for information on additional codes. Diagnosis codes should be selected only by a health care professional. This information is subject to change. Merck cautions that payer-coding requirements vary and can frequently change, so it is important to regularly check with each payer or, where applicable, the Medicare Administrative Contractor as to payer-specific requirements.

You are solely responsible for determining the appropriate codes and for any action you take in billing. The information provided here is not intended to be definitive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. Diagnosis codes should be selected only by a health care professional. Merck and its agents make no warranties or guarantees, expressed or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs.

NDC and Packaging Information

The NDC is typically required when submitting a claim with a miscellaneous HCPCS code. Please consult with the payer to understand specific billing requirements.

PRODUCT KEYTRUDA® (pembrolizumab) injection 100 mg
PACKAGE Carton containing one 100 mg/4 mL (25 mg/mL), single-use vial
NDC 0006-3026-02

Please note: The NDC above is the billable NDC that appears on the carton. The NDC on the vial should not be used for billing purposes.

Billing Codes

Below is a list of possible codes that could be relevant for KEYTRUDA and its administration. Please consult with the applicable payer to understand the payer’s specific billing requirements.

 

HCPCS Code for KEYTRUDA1

HCPCS CODE DESCRIPTOR
J9271
(effective January 1, 2016)
Injection, pembrolizumab, 1 mg

Revenue Code–For Use in the Hospital Inpatient Setting2

REVENUE CODE DESCRIPTOR
0636 Drug requiring detailed coding

Current Procedural Terminology (CPT®)a Code for Administration3

CPT CODE DESCRIPTOR
96413
(Some payers may utilize 96365. Check with the applicable payer.)
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

aCPT Copyright 2017 American Medical Association. All rights reserved.