Billing and coding guide

A quick reference guide as you navigate access and reimbursement for BENLYSTA.

Find helpful information on BENLYSTA codes and ICD-10 descriptions on this page. 

ICD-10 = 10th edition of the International Classification of Diseases, a standardized system for coding and classifying diseases and medical conditions.

BENLYSTA codes and descriptions

BENLYSTA billing and coding requirements may vary based on factors such as where the drug is administered, the type of insurance the patient has, and the patient’s status and medical history.

Below is a billing and coding quick reference guide for BENLYSTA

Use of the codes below does not guarantee reimbursement.

Healthcare Common Procedure Coding System — HCPCS (Product)
Code Description
J0490 Injection, belimumab, 10 mg
Current Procedural Terminology — CPT (Procedure)
Code Description
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specific substance or drug); initial, up to 1 hour
96413* Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance or drug
National Drug Code — NDC Number†
Code Description
10-digit:
49401-101-01
11-digit:
49401-0101-01
 120 mg belimumab in a 5-mL single-dose vial
Code Description
10-digit:
49401-102-01
11-digit:
49401-0102-01
 400 mg belimumab in a 20-mL single-dose vial
Revenue Code
Code Description
0636 Drugs requiring detailed coding
0260 IV therapy
0250 General pharmacy or biologics
  • *

    The American Medical Association (AMA) has recognized the use of the 96413 administration code for some non-chemotherapy substances, such as certain monoclonal antibody agents and other biologic response modifiers. Since BENLYSTA is a human monoclonal antibody agent, this CPT code may be applicable. However, recognition of chemotherapy administration codes for non-chemotherapy drugs may vary by payer, and the documentation must support the use of these codes.

  • †

    The coding, coverage, reimbursement, and related information presented in this guide is from various third-party sources and is subject to change without notice. GSK cannot guarantee the accuracy or timeliness of these data. This information should not be considered a guarantee of success in obtaining third-party insurance payment for any product and should not be relied upon without confirmation. The decision by a payer to pay for a specific product is based on many factors. It is always the prescriber’s responsibility to determine the appropriate treatment and submit appropriate codes, charges, and modifiers for treatments provided. Providers should contact third-party payers for specific information on their policies.

  • IV = intravenous.

     

ICD-10+ ICD-10 Description
Providers are responsible for selecting the diagnosis code that is supported by the patient’s condition and documented in the medical record.
M32.10 Systemic lupus erythematosus, organ or system involvement unspecified
M32.11 Endocarditis in systemic lupus erythematosus
M32.12 Pericarditis in systemic lupus erythematosus
M32.13 Lung involvement in systemic lupus erythematosus
M32.14 Glomerular disease in systemic lupus erythematosus
M32.15 Tubulo-interstitial nephropathy in systemic lupus erythematosus
M32.19 Other organ or system involvement in systemic lupus erythematosus
M32.8 Other forms of systemic lupus erythematosus
M32.9 Systemic lupus erythematosus, unspecified

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Together with BENLYSTA

Once you have made a decision to prescribe BENLYSTA, Together with BENLYSTA is your trusted resource to help appropriate patients with the tools they need to stay on track. It’s more than a support program—it's a promise to create meaningful connections for your patients and the experience they deserve.

1-877-4-BENLYSTA (1-877-423-6597)

Monday to Friday, 8 AM to 8 PM ET

Select option 1 for Together with BENLYSTA

Go to Together with BENLYSTA HCP homepage

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Together with BENLYSTA

Together with BENLYSTA is your trusted resource to help appropriate patients with the tools they need to stay on track. It’s more than a support program—it's a promise to create meaningful connections for your patients and the experience they deserve.

GO TO TOGETHERWITHBENLYSTA.COM

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Indication & Safety Info

Indication

Important Safety Information

Indication

BENLYSTA is indicated for patients aged ≥5 with active systemic lupus erythematosus (SLE) or active lupus nephritis who are receiving standard therapy. BENLYSTA is not recommended in patients with severe active central nervous system lupus.

Important Safety Information

CONTRAINDICATION

Previous anaphylaxis with BENLYSTA.

WARNINGS AND PRECAUTIONS

Serious Infections: Serious and sometimes fatal infections have been reported and occurred more frequently with BENLYSTA. Use caution in patients with severe or chronic infections, and consider interrupting therapy in patients with a new infection.

 

Progressive Multifocal Leukoencephalopathy (PML): Cases of JC virus-associated PML resulting in neurological deficits, including fatal cases, have been reported. If PML is suspected, immunosuppressant therapy, including BENLYSTA, must be suspended until PML is excluded. If confirmed, stop immunosuppressant therapy, including BENLYSTA.

 

Hypersensitivity Reactions (Including Anaphylaxis): Acute hypersensitivity reactions, including anaphylaxis and death, and infusion-related reactions have been reported. Generally, reactions occurred within hours of the infusion but may occur later, including in patients who have previously tolerated BENLYSTA. Non-acute hypersensitivity reactions (eg, rash, nausea, fatigue, myalgia, headache, and facial edema) typically occurred up to a week after infusion. Monitor patients during and after treatment and be prepared to manage anaphylaxis and infusion-related reactions. Be aware of the risk of hypersensitivity reactions, which may present as infusion-related reactions. Discontinue immediately in the event of a serious reaction. With intravenous administration, if an infusion reaction develops, slow or interrupt the infusion.

 

Depression and Suicidality: Depression and suicidality were reported in patients receiving BENLYSTA. Before adding BENLYSTA, assess patients’ risk of depression and suicide and monitor them during treatment. Instruct patients/caregivers to contact their HCP if they experience new/worsening depression, suicidal thoughts/behavior, or other mood changes.

 

Malignancy: There is an increased risk of malignancies with the use of immunosuppressants. The impact of BENLYSTA on the development of malignancies is unknown.

 

Immunization: Live vaccines should not be given for 30 days before or concurrently with BENLYSTA as clinical safety has not been established.

 

Use With Biologic Therapies: Available data do not support the safety and efficacy of concomitant use of BENLYSTA with rituximab in patients with SLE. An increased incidence of serious infections and post-injection systemic reactions in patients receiving BENLYSTA concomitantly with rituximab compared to patients receiving BENLYSTA alone has been observed. The safety and efficacy of BENLYSTA concomitantly with other biologic therapies, including B-cell-targeted therapies, have not been established. Caution should be exercised if BENLYSTA is administered in combination with other biologic therapies.

 

ADVERSE REACTIONS

The most common serious adverse reactions in adult SLE clinical trials were serious infections; some were fatal. The most common adverse reactions (≥5%) were nausea, diarrhea, pyrexia, nasopharyngitis, bronchitis, insomnia, pain in extremity, depression, migraine, pharyngitis, and injection site reactions (subcutaneous injection).

 

Adverse reactions reported in clinical trials with SLE pediatric patients (≥5 years) and adult patients with lupus nephritis were consistent with those observed in adult SLE trials.

 

USE IN SPECIFIC POPULATIONS

Pregnancy: There are insufficient data in pregnant women to establish whether there is drug-associated risk for major birth defects or miscarriage. After a risk/benefit assessment, if prevention is warranted, women of childbearing potential should use contraception during treatment and for ≥4 months after the final treatment.

 

Pregnancy Registry: HCPs are encouraged to refer patients and pregnant women are encouraged to enroll themselves by calling 1-877-311-8972 or visiting https://mothertobaby.org/ongoing-study/benlysta-belimumab/.

 

Please see full Prescribing Information and Medication Guide for BENLYSTA.

To report SUSPECTED ADVERSE REACTIONS, contact GSK at gsk.public.reportum.com or 1-888-825-5249, or
FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Reference

1.    Medicare Coverage Database. CMS.gov.