Billing and Coding: Instructions for Lemtrada® (alemtuzumab) When Used in the Treatment of Relapsing Multiple Sclerosis

Lemtrada (alemtuzumab) is covered for treatment of relapsing forms of multiple sclerosis when billed with ICD-10-CM G35.A or G35.C1 and administered per FDA dosing (12 mg IV daily: first course 5 consecutive days, second course 3 consecutive days ~1 year later). Claims must use HCPCS J0202 (as applicable by DOS), include the NDC 58468-0200-1 or 58468-0200-01, and provide the drug name, dose, route, and NDC in the required UB-04 or CMS-1500 narrative fields; dosages other than 12 mg/day, unlisted NDCs, or wastage reporting will be rejected.

"Treatment of relapsing forms of multiple sclerosis with documented diagnosis code ICD-10-CM G35."

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