BENLYSTA billing and coding guide

A summary of access and reimbursement details to help support you and your practice.

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

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.

Code Set Code Description
Healthcare Common Procedure Coding System – HCPCS (Product) J0490 Injection, belimumab, 10 mg
Current Procedural Terminology – CPT (Procedure) 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 10-digit 11-digit Description
49401-101-01 49401-0101-01 120 mg belimumab in a 5-mL single-dose vial
  49401-102-01 49401-0102-01 400 mg belimumab in a 20-mL single-dose vial
Revenue Code 0636 Drugs requiring detailed coding
0260 IV therapy
0250 General pharmacy or biologics
Code Set Code Description
Healthcare Common Procedure Coding System – HCPCS (Product) J0490 Injection, belimumab, 10 mg
Current Procedural Terminology – CPT (Procedure) 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 10-digit Description
49401-101-01 120 mg belimumab in a 5-mL single-dose vial
49401-102-01 400 mg belimumab in a 20-mL single-dose vial
National Drug Code – NDC Number 11-digit Description
49401-0101-01 120 mg belimumab in a 5-mL single-dose vial
49401-0102-01 400 mg belimumab in a 20-mL single-dose vial
Revenue Code 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.

ICD-101 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.
M32.0 Drug-induced systemic lupus erythematosus
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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