Reimbursement & Acquisition

Coding and Claims Processing

The key to reducing unnecessary insurance paperwork is to submit accurately coded claim forms the first time. Here you'll find the codes required to bill or Sandostatin LAR® Depot (octreotide acetate for injectable suspension), on most types of claim forms:

• ICD-9-CM Diagnosis Codes
• CPT Procedure Codes
• HCPCS Codes for Medicare Reimbursement
• NDC Numbers
• Hospital Revenue Codes
• Laboratory Test Codes

Please note that the codes may vary by the setting in which Sandostatin LAR® Depot is administered. The exact choice of codes depends on the standard coding practices of the physicians in your community and on each insurer.

ICD-9-CM Diagnosis Codes

Medicare and Private Payers require that claim forms include an International Classification of Diseases Clinical Modification (ICD-9-CM) diagnosis code to describe the patient's condition. The diagnosis codes that may apply for Sandostatin LAR® Depot include:

• 253.0 — acromegaly and gigantism
• 259.2 — carcinoid syndrome (intestinal, metastatic)
• 157.4 — malignant neoplasm of islets of Langerhans
• 211.7 — benign neoplasm of islets of Langerhans

CPT Procedure Codes

In addition to the diagnosis code, health care professionals should bill the appropriate procedure (CPT) code for providing Sandostatin LAR® Depot. Providers may use one of the following to bill for the service:

• 90772 — Therapeutic or diagnostic injection (specify subcutaneous or intramuscular on the claim form). Using this code allows billing of Medicare for both the injection and the office visit on the same day
• 99201 - 99215* — evaluation and management visit codes, if applicable

HCPCS Codes for Medicare Reimbursement

Medicare requires physicians and providers to bill for injectable drugs with HCPCS codes. Use of these codes helps facilitate faster reimbursement.

• J2353 — Sandostatin LAR® Depot (linked to APC code 1207)
• J2354 — Immediate release Sandostatin® Injection (linked to APC code 7031)
• The number of units billed should correspond to the dosage administered. For example, 30 units would be the multiplier used when a 30 mg vial of Sandostatin LAR® Depot is administered.

Currently, Sandostatin LAR® Depot and immediate release Sandostatin® Injection have a "K" status in the APC in the OPPS. Drugs and biologicals with a "K" status are paid in separate APCs under the OPPS.

For accurate reimbursement, be sure to check the HCPCS Code Listing to use the current correct multiplier for Sandostatin LAR® Depot. Also, please note that plans may have specific billing requirements. It is often a good idea to spell out the name of the product as follows:

• Sandostatin LAR® Depot
• Immediate release Sandostatin® Injection

NDC Numbers

The US Food and Drug Administration (FDA) has issued the following National Drug Code (NDC) numbers for Sandostatin LAR® Depot:

	10 mg Sandostatin LAR® Depot NDC 0078-0340-61
	20 mg Sandostatin LAR® Depot NDC 0078-0341-61
	30 mg Sandostatin LAR® Depot NDC 0078-0342-61

Hospital Revenue Codes

Hospitals use revenue codes developed by the American Hospital Association to bill for services and supplies furnished during an outpatient encounter. For Sandostatin LAR® Depot, the hospital may bill the following revenue codes in addition to the HCPCS code for the drug:

• 250 — general pharmacy
• 510 — clinic visit
• 520 — freestanding clinic visit

If it is unclear which revenue code is most appropriate, check with the patient's insurer, or call the Sandostatin® Therapy Support Hotline toll-free at 1-877-LAR-HELP.

Laboratory Test Codes

In addition to the codes needed for billing the drug, the following codes can be used for billing the laboratory tests conducted for monitoring patients:

• 86316 — Chromogranin-A (CgA)
• 83497 — 5-Hydroxyindolacetic acid (5-HIAA)
• Somatostatin receptor scintigraphy (SRS) testing:
  • 78607 — Brain imaging
  • 78647 — Cerebrospinal fluid flow
• 84305 — Insulin-like growth factor-I (IGF-I)
• 83003 — Growth hormone (GH)

These lab tests are typically covered if the patient is insured. They are also non-invasive and can be useful in diagnosing and monitoring patients.