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Coverage details clarified
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Offers guidance that may be helpful when establishing medical necessity
Specialty distributors who are authorized to sell JEMPERLI
Specialty Distributor |
Phone |
Item # |
|---|---|---|
ASD Specialty Healthcare |
1-800-746-6273 |
10257721 |
Cardinal Health Specialty |
1-855-855-0708 |
5717897 |
McKesson Plasma and Biologics |
1-877-625-2566 |
2332104 |
McKesson Specialty |
1-800-482-6700 |
5011010 |
Oncology Supply |
1-800-633-7555 |
10257701 |
JEMPERLI billing and coding information
J9272
Injection, dostarlimab-gxly, 10mg
Additional information needed may vary by payer and may include the drug name and generic name, total dosage administered, method of administration, and the NDC. Providers should confirm this information by payer.
Code set |
Code |
Description |
How Supplied |
|---|---|---|---|
National Drug Code (NDC) |
00173-0898-03 |
JEMPERLI (dostarlimab-gxly) |
Injection: clear to slightly opalescent, colorless to yellow solution supplied in a carton containing one 500 mg/10mL (50 mg/mL), single-dose vial |
The coding, coverage, reimbursement, and related information presented above is from various third-party sources and is subject to change without notice. GSK cannot guarantee the accuracy or timeliness of these data.
ICD-10 codes
ICD-10-CM Diagnosis Codes for JEMPERLI |
|
|---|---|
C54 Malignant neoplasm of corpus uteri |
|
C54.0 |
Malignant neoplasm of isthmus uteri |
C54.1 |
Malignant neoplasm of endometrium |
C54.2 |
Malignant neoplasm of myometrium |
C54.3 |
Malignant neoplasm of fundus uteri |
C54.8 |
Malignant neoplasm of overlapping sites of corpus uteri |
C54.9 |
Malignant neoplasm of overlapping sites of corpus uteri |
C55 Malignant neoplasm of corpus uteri |
|
C55 |
Malignant neoplasm of corpus uteri, unspecified |
D07 Carcinoma in situ of other and unspecified genital organs |
|
D07.0 |
Malignant neoplasm of endometrium |
The billing and coding information provided is for your reference only. Reimbursement codes are subject to frequent changes. The accurate completion of claims documentation is the responsibility of the healthcare provider. GSK does not guarantee reimbursement for any services or products.
The following table lists possible ICD-10-CM diagnosis codes applicable for JEMPERLI treatment. It is important to clarify individual payer diagnosis coding requirements for each patient.
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The information provided by the ARM is not a guarantee of coverage or reimbursement.