HCPCS
J9308
1 unit = 5 mg
Phase 1
Identify what you're billing
Cyramza is a single-product code — no biosimilars in the U.S. — but dosing varies by indication.
About Cyramza (ramucirumab) FDA label + Lilly Oncology 2026
Fully human IgG1 monoclonal antibody that binds the VEGFR2 receptor and blocks the binding of VEGF ligands (VEGF-A, VEGF-C, VEGF-D), inhibiting downstream ligand-induced receptor signaling and angiogenesis.
Cyramza (generic name: ramucirumab) is a fully human IgG1 monoclonal antibody manufactured by Eli Lilly and Company (Indianapolis, IN). It is a targeted anti-angiogenic agent that binds the extracellular domain of VEGFR2 (vascular endothelial growth factor receptor 2) — mechanistically distinct from bevacizumab (Avastin, J9035), which binds the VEGF-A ligand itself rather than the receptor. The two drugs are not interchangeable on the claim form, even where indications overlap.
Cyramza was first approved by the FDA on April 21, 2014 for advanced gastric or gastroesophageal junction (GEJ) adenocarcinoma in patients with disease progression on or after prior fluoropyrimidine- or platinum-containing chemotherapy (REGARD trial). Indication expansions followed: NSCLC + docetaxel in 2014 (REVEL), mCRC + FOLFIRI in 2015 (RAISE), and HCC post-sorafenib with AFP ≥ 400 ng/mL in 2019 (REACH-2). The HCC indication is the only one with a biomarker gate; the AFP ≥ 400 ng/mL threshold is FDA-labeled and enforced by Medicare and commercial payers.
Cyramza is administered as a 60-minute IV infusion and carries an FDA boxed warning for hemorrhage, gastrointestinal perforation, and impaired wound healing. Hypertension and proteinuria monitoring are FDA-label-required and routinely audited by payers at PA renewal.
Single-source product. Cyramza has no FDA-approved biosimilar in the U.S. as of May 2026.
All ramucirumab claims bill under J9308 with Lilly NDCs only. There is no Q-code biosimilar pathway to
steer to.
Dosing per indication FDA label + NCCN 2025–2026
Four FDA-approved indications, three different doses/schedules. Indication-specific dosing tied to the pivotal trial regimen. All doses are weight-based (mg/kg) — partial-vial waste is the rule.
Indication-specific dosing matrix
| Indication | Cyramza dose | Schedule | Combo partner | Biomarker / line |
|---|---|---|---|---|
| Gastric / GEJ adenocarcinoma (post-platinum / fluoropyrimidine) | 8 mg/kg | IV q2wk (day 1, 28-day equivalent) | Monotherapy (REGARD) OR + paclitaxel 80 mg/m² D1, 8, 15 of 28-day (RAINBOW) | Disease progression on/after prior platinum or fluoropyrimidine |
| Metastatic NSCLC (post-platinum) | 10 mg/kg | IV q3wk (day 1 of 21-day cycle) | + docetaxel 75 mg/m² q3wk (REVEL) | Disease progression on/after platinum chemo |
| Metastatic NSCLC — 1L EGFR mutant (exon 19 del or L858R) | 10 mg/kg | IV q2wk (day 1 of 14-day cycle) | + erlotinib 150 mg PO daily (RELAY) | Untreated metastatic NSCLC w/ EGFR exon 19 deletion or exon 21 L858R mutation |
| Metastatic CRC (post-bevacizumab/oxaliplatin/fluoropyrimidine) | 8 mg/kg | IV q2wk (day 1 of 14-day cycle) | + FOLFIRI (RAISE) | Disease progression on/after bevacizumab, oxaliplatin, and a fluoropyrimidine |
| Hepatocellular carcinoma (HCC) (post-sorafenib) | 8 mg/kg | IV q2wk | Monotherapy (REACH-2) | AFP ≥ 400 ng/mL AND prior sorafenib |
The dose is set by the indication, not by the patient. NSCLC at 10 mg/kg q3wk is a
higher per-dose mg total than gastric/CRC/HCC at 8 mg/kg q2wk for the same weight. Verify the chemo order
and the indication-specific dose before billing; mis-applied doses are a common audit finding.
Worked example — gastric monotherapy (80 kg patient, 8 mg/kg q2wk)
# Calculate dose
Dose: 8 mg/kg × 80 kg = 640 mg
Units (1 unit = 5 mg): 640 / 5 = 128 units J9308
# Vial draw
Option A: 1 × 500 mg + 2 × 100 mg vials = 700 mg drawn; discard 60 mg (12 units waste)
Option B: 6 × 100 mg + 1 partial 500 mg — not preferred (more vials, higher contamination risk)
Best: Option A → 700 mg drawn, 640 mg administered, 60 mg (12 units) waste
# Drug claim lines
Line 1 (administered): J9308 · 128 units
Line 2 (waste): J9308 · 12 units · modifier JW
# Admin claim line
96413 (chemo IV, up to 1 hour) — 60-min infusion fits the initial-hour window
# Drug reimbursement (Q2 2026 ASP+6% = $75.472 per 5 mg unit)
Total billed units: 128 + 12 = 140 units × $75.472 = $10,566.08 (admin + waste both pay)
Dose: 8 mg/kg × 80 kg = 640 mg
Units (1 unit = 5 mg): 640 / 5 = 128 units J9308
# Vial draw
Option A: 1 × 500 mg + 2 × 100 mg vials = 700 mg drawn; discard 60 mg (12 units waste)
Option B: 6 × 100 mg + 1 partial 500 mg — not preferred (more vials, higher contamination risk)
Best: Option A → 700 mg drawn, 640 mg administered, 60 mg (12 units) waste
# Drug claim lines
Line 1 (administered): J9308 · 128 units
Line 2 (waste): J9308 · 12 units · modifier JW
# Admin claim line
96413 (chemo IV, up to 1 hour) — 60-min infusion fits the initial-hour window
# Drug reimbursement (Q2 2026 ASP+6% = $75.472 per 5 mg unit)
Total billed units: 128 + 12 = 140 units × $75.472 = $10,566.08 (admin + waste both pay)
Worked example — NSCLC + docetaxel (80 kg, 10 mg/kg q3wk)
# Calculate dose
Cyramza: 10 mg/kg × 80 kg = 800 mg (J9308, 160 units)
Vial draw: 1 × 500 mg + 3 × 100 mg = 800 mg drawn; zero waste, JZ applies
Docetaxel: 75 mg/m² × 1.8 BSA = 135 mg (J9171, separate claim line)
# Schedule (21-day cycle)
Day 1: Cyramza 800 mg + docetaxel 135 mg
Days 2–21: rest
Cycle repeats q3wk until disease progression / unacceptable toxicity
Cyramza: 10 mg/kg × 80 kg = 800 mg (J9308, 160 units)
Vial draw: 1 × 500 mg + 3 × 100 mg = 800 mg drawn; zero waste, JZ applies
Docetaxel: 75 mg/m² × 1.8 BSA = 135 mg (J9171, separate claim line)
# Schedule (21-day cycle)
Day 1: Cyramza 800 mg + docetaxel 135 mg
Days 2–21: rest
Cycle repeats q3wk until disease progression / unacceptable toxicity
Worked example — HCC monotherapy (75 kg, AFP 612 ng/mL)
# Eligibility check
Prior sorafenib: documented
Serum AFP: 612 ng/mL (≥ 400 threshold met)
# Dose
8 mg/kg × 75 kg = 600 mg (J9308, 120 units)
Vial draw: 1 × 500 mg + 1 × 100 mg = 600 mg drawn; JZ applies (no waste)
# Documentation packet (HCC PA)
Required: AFP lab report (≥ 400 ng/mL), prior sorafenib chart note, C22.0 ICD-10, BCLC stage
Prior sorafenib: documented
Serum AFP: 612 ng/mL (≥ 400 threshold met)
# Dose
8 mg/kg × 75 kg = 600 mg (J9308, 120 units)
Vial draw: 1 × 500 mg + 1 × 100 mg = 600 mg drawn; JZ applies (no waste)
# Documentation packet (HCC PA)
Required: AFP lab report (≥ 400 ng/mL), prior sorafenib chart note, C22.0 ICD-10, BCLC stage
Premedication
Per FDA label, premedicate with an H1 antagonist (e.g., diphenhydramine) prior to each Cyramza infusion. For patients who have experienced a prior grade 1 or 2 infusion-related reaction, also premedicate with dexamethasone (or equivalent) and acetaminophen prior to each subsequent infusion. Permanently discontinue for grade 3 or 4 infusion-related reactions.
NDC reference FDA NDC Directory + Lilly billing guide verified May 2026
| NDC | Strength | Package size | Units / vial |
|---|---|---|---|
0002-7669-01 |
100 mg / 10 mL (10 mg/mL) | 1 single-dose vial per carton | 20 units (1 unit = 5 mg) |
0002-7678-01 |
500 mg / 50 mL (10 mg/mL) | 1 single-dose vial per carton | 100 units (1 unit = 5 mg) |
Use carton-level NDC with N4 qualifier. Payers expect the 11-digit NDC (hyphens or
no-hyphens by payer) in the 24A shaded area with the N4 qualifier and total volume drawn (ML). Vial-level
NDC variants will trigger denial. Both vial sizes are single-dose — discard unused portion (single-dose
container policy applies, bill JW for waste).
Vial selection matters for waste. The 500 mg vial dramatically reduces waste for doses
≥ 500 mg. For an 80 kg gastric patient (640 mg), 1 × 500 + 2 × 100 = 700 mg drawn (60 mg
waste) is the lowest-waste combo. For a 110 kg NSCLC patient (10 mg/kg = 1,100 mg), 2 × 500 + 1 ×
100 = 1,100 mg, zero waste (JZ). Pharmacy and biller should coordinate on vial selection where multiple
combinations work.
Phase 2
Code the claim
Chemo admin codes apply. JW for waste is the rule, not the exception. AFP documentation for HCC is non-negotiable.
Administration codes CPT verified May 2026
Cyramza is HCPCS chemotherapy-classified. Use chemo admin codes (96413/96415), not therapeutic infusion codes (96365/96366).
| Code | Description | When to use |
|---|---|---|
96413 |
Chemotherapy administration, IV infusion technique; up to 1 hour, single or initial substance/drug | Primary code for Cyramza. 60-minute standard infusion fits the 1-hour window. Bill once per encounter as the initial chemo agent. |
96415 |
Chemotherapy administration, IV infusion; each additional hour (List separately) | Add when total infusion runs over 1 hour (e.g., infusion rate held back for tolerability or first infusion observation). One unit per additional hour or part thereof beyond the initial 60 minutes. |
96417 |
Chemo IV infusion, each additional sequential infusion (different drug) | For the second chemo agent in a combo regimen (paclitaxel after Cyramza in RAINBOW gastric, docetaxel after Cyramza in REVEL NSCLC, FOLFIRI components in RAISE mCRC). |
96365 / 96366 |
Therapeutic IV infusion (non-chemo) | NOT appropriate for Cyramza. Ramucirumab is HCPCS chemo-classified; chemo admin codes are the correct pairing across all payers. |
Combo regimen sequencing varies by indication. In NSCLC + docetaxel, Cyramza is infused
first followed by docetaxel. In RAINBOW gastric (Cyramza + paclitaxel), Cyramza precedes paclitaxel on
day 1. In RAISE mCRC, Cyramza precedes FOLFIRI components. Bill 96413 for Cyramza (initial chemo), then
96417 for each sequential chemo agent.
Modifiers CMS verified May 2026
JW — the default for Cyramza
JW reports the discarded portion of a single-dose vial. Because Cyramza dosing is weight-based and vials are 100 mg + 500 mg single-dose, partial-vial waste occurs on most doses unless the calculated mg lands exactly on a 100 or 500 mg combination. JW applies to most J9308 claims. Bill the administered units on the primary line and the wasted units on a separate line with the JW modifier. Both lines pay at ASP+6%.
Worked JW example — 80 kg gastric patient, 8 mg/kg q2wk
# Dose
8 mg/kg × 80 kg = 640 mg ordered
# Lowest-waste vial draw
1 × 500 mg + 2 × 100 mg = 700 mg drawn
Administered: 640 mg | Discarded: 60 mg
# Convert to units (1 unit = 5 mg)
Administered: 640 / 5 = 128 units
Wasted: 60 / 5 = 12 units (JW)
# Claim lines
Line 1: J9308 · 128 units · (no modifier for admin line when JW is on waste line)
Line 2: J9308 · 12 units · modifier JW
# Worked JZ example — 80 kg NSCLC, 10 mg/kg q3wk
10 mg/kg × 80 kg = 800 mg = 1 × 500 + 3 × 100 vials = 800 mg drawn
Zero waste; entire dose administered → J9308 · 160 units · modifier JZ
8 mg/kg × 80 kg = 640 mg ordered
# Lowest-waste vial draw
1 × 500 mg + 2 × 100 mg = 700 mg drawn
Administered: 640 mg | Discarded: 60 mg
# Convert to units (1 unit = 5 mg)
Administered: 640 / 5 = 128 units
Wasted: 60 / 5 = 12 units (JW)
# Claim lines
Line 1: J9308 · 128 units · (no modifier for admin line when JW is on waste line)
Line 2: J9308 · 12 units · modifier JW
# Worked JZ example — 80 kg NSCLC, 10 mg/kg q3wk
10 mg/kg × 80 kg = 800 mg = 1 × 500 + 3 × 100 vials = 800 mg drawn
Zero waste; entire dose administered → J9308 · 160 units · modifier JZ
JZ — only when no waste
JZ applies when the calculated dose equals an exact 100 mg / 500 mg vial combination (e.g., a patient at exactly 100 kg in NSCLC at 10 mg/kg = 1,000 mg = 2 × 500 mg vials, zero waste). One of JZ or JW must be on every J9308 claim per CMS's July 2023 single-dose container policy.
Common error: Omitting the JW waste line. CMS audits routinely catch this — the
wasted drug is reimbursable but must be reported on a separate claim line. Both administered and
discarded units pay at ASP+6%.
Modifier 25 — same-day E/M
Use modifier 25 on the E/M code when a significant, separately identifiable evaluation and management service is performed on the same day as the infusion. Routine pre-infusion clinical assessment is bundled into the chemo admin code.
340B modifiers (JG, TB)
For 340B-acquired Cyramza, follow your MAC's current 340B modifier policy. Hospital outpatient departments billing under OPPS are subject to specific 340B reporting requirements; office-based 340B reporting varies by MAC.
ICD-10-CM by indication FY2026 verified May 2026
Four FDA-approved indications. Use the most specific code supported by encounter documentation; pair with secondary metastatic codes (C77–C79) where applicable.
| Indication | ICD-10 family | Notes |
|---|---|---|
| Stomach — cardia | C16.0 | Use for cardia-region gastric adenocarcinoma |
| Stomach — fundus / body / antrum / pylorus / lesser-greater curvature | C16.1 / C16.2 / C16.3 / C16.4 / C16.5-C16.6 | Site-specific stomach malignancies |
| Stomach — overlapping / unspecified | C16.8 / C16.9 | Use when site documentation is incomplete |
| Gastroesophageal junction (GEJ) | C16.0 (cardia includes GEJ in some payer policies) | Some payers accept C15.5 (lower-third esophagus) for GEJ; follow payer guidance |
| NSCLC — upper lobe (R/L) | C34.10 / C34.11 / C34.12 | Unspec / right / left upper lobe |
| NSCLC — middle lobe (R) | C34.2 | Right middle lobe (no left middle lobe) |
| NSCLC — lower lobe (R/L) | C34.30 / C34.31 / C34.32 | Unspec / right / left lower lobe |
| NSCLC — main bronchus / overlapping / NOS | C34.0x / C34.8x / C34.9x | Use when histology is non-small-cell but lobe documentation is incomplete |
| Colon — site-specific | C18.0–C18.9 | Cecum, ascending, transverse, descending, sigmoid, overlap, NOS |
| Rectosigmoid junction | C19 | Rectosigmoid mCRC |
| Rectum | C20 | Rectal mCRC |
| Hepatocellular carcinoma | C22.0 | Required for HCC indication. Pair with documented AFP ≥ 400 ng/mL and prior sorafenib in PA packet. |
| Secondary malignancy (paired) | C77–C79 | Add for nodal (C77.x), respiratory/digestive (C78.x), or other site (C79.x) metastases |
Indication-specific PA criteria are the norm. All four indications require line-of-therapy
documentation (prior platinum for gastric, prior platinum for NSCLC, prior bevacizumab+oxaliplatin+
fluoropyrimidine for mCRC, prior sorafenib for HCC). HCC additionally requires AFP ≥ 400 ng/mL
lab documentation. ICD-10 alone is not sufficient for approval.
Site of care & place of service Verified May 2026
Cyramza is typically administered in oncology offices, ambulatory infusion centers (freestanding infusion suites), and hospital outpatient departments. The 60-minute infusion fits the standard 96413 chemo initial-hour window. Major commercial payers run site-of-care UM for high-cost oncology drugs and increasingly steer infusion out of HOPD into office or freestanding AIC settings.
| Setting | POS | Claim form | Payer steering |
|---|---|---|---|
| Physician oncology office | 11 | CMS-1500 / 837P | Preferred by commercial UM |
| Freestanding ambulatory infusion suite (AIC) | 49 | CMS-1500 / 837P | Preferred by commercial UM |
| Oncology ASC | 24 | CMS-1500 / 837P | Acceptable |
| Hospital outpatient (on-campus HOPD) | 22 | UB-04 / 837I | Disfavored after first cycles by commercial site-of-care UM |
| Hospital outpatient (off-campus PBD) | 19 | UB-04 / 837I | Disfavored |
| Patient home | 12 | CMS-1500 (home infusion) | Rare for ramucirumab; not standard route |
Site-of-care UM is aggressive for ramucirumab. UHC's Optum-managed program and Aetna's
Site-of-Care policy both steer Cyramza administration out of HOPD into office (POS 11) or freestanding
AIC (POS 49). If the patient must be in HOPD for clinical reasons (e.g., comorbidities requiring
hospital-level rescue capability), submit a medical-necessity letter at the SOC review stage.
Claim form field mapping Lilly Oncology billing guide 2026
From Lilly Oncology Support Center Cyramza billing & coding guide.
| Information | CMS-1500 box | Notes |
|---|---|---|
| NPI | 17b | Rendering provider |
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | N4 + 0002-7669-01 (100 mg) or 0002-7678-01 (500 mg) + ML + total volume drawn (e.g., 70 mL for 700 mg drawn) |
| HCPCS J9308 (administered line) | 24D (drug line) | Administered units only; larger line |
| HCPCS J9308 + JW (waste line) | 24D (waste line) | Wasted units only; almost always present for weight-based dosing |
| Drug units | 24G | Mg administered ÷ 5 (e.g., 128 units for 640 mg) |
| CPT 96413 (admin line) | 24D (admin line) | Chemo IV, up to 1 hour (60-min infusion fits) |
| CPT 96415 | 24D | Each additional hour beyond initial 60 minutes (rare for Cyramza alone) |
| CPT 96417 | 24D | Each additional sequential chemo agent (paclitaxel, docetaxel, FOLFIRI components) |
| ICD-10 | 21 | Indication-specific (C16.x gastric, C34.x NSCLC, C18–C20 mCRC, C22.0 HCC) |
| PA number | 23 | Required by all major commercial payers |
Phase 3
Get paid
PA + indication-specific line-of-therapy docs are the rule. HCC requires AFP ≥ 400 in the packet.
Payer policy snapshot Reviewed May 2026
All major payers require PA. Indication-specific documentation requirements vary; combo agents have their own PA.
| Payer | PA? | Indication-specific requirements | Site-of-care UM |
|---|---|---|---|
| UnitedHealthcare Oncology Med Coverage Policy |
Yes | Gastric: documented prior platinum/fluoropyrimidine. NSCLC: prior platinum + concurrent docetaxel PA. mCRC: prior bevacizumab + oxaliplatin + fluoropyrimidine + concurrent FOLFIRI components. HCC: prior sorafenib + AFP ≥ 400 lab. | Aggressive: chemo steered out of HOPD via Optum-managed program |
| Aetna CPB + Medical Drug policies |
Yes | Aligned with NCCN and FDA label; line-of-therapy documentation required; HCC AFP ≥ 400 enforced | Yes (separate Site-of-Care policy) |
| Cigna Specialty Drug Coverage Policy |
Yes | NCCN + FDA label aligned; HTN/proteinuria baseline labs required for renewal | Yes |
| BCBS plans Vary by plan |
Yes | Generally aligned with NCCN guidelines + FDA label requirements; HCC AFP ≥ 400 enforced | Plan-specific; most have oncology site-of-care steering |
Step therapy
Step therapy is largely encoded in the line-of-therapy requirements (post-platinum, post-bevacizumab, post-sorafenib). Cyramza is not generally a first-line agent for any of its four indications — prior therapy failure is the gate. Some plans additionally require documentation that anti-PD-1 immunotherapy was considered (NSCLC) or that alternative VEGF-pathway agents (e.g., bevacizumab) were considered or contraindicated (mCRC). Verify each payer's specific step ladder.
NCCN compendium support
Cyramza is included in NCCN Gastric, NSCLC, Colon/Rectal, and Hepatocellular guidelines as the FDA-approved regimens. Off-label NCCN-supported uses are limited; most coverage hinges on the four on-label indications.
Medicare reimbursement CMS Q2 2026 (live)
Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter.
Q2 2026 payment snapshot — J9308
Effective April 1 – June 30, 2026 · Based on 4Q25 ASP submissions
ASP + 6%
$75.472
per 5 mg unit
640 mg gastric dose
$9,660.42
8 mg/kg × 80 kg
800 mg NSCLC dose
$12,075.52
10 mg/kg × 80 kg
Wasted drug is reimbursable. Bill the JW line for the discarded portion — both
administered and discarded units pay at ASP+6%. For a 640 mg gastric dose drawn from 1 × 500 mg + 2
× 100 mg vials: 140 units total billed (128 administered + 12 waste) = $10,566.08
drug reimbursement before sequestration.
Sequestration: Approximately 2% reduction applies to actual paid amount, bringing
effective reimbursement to roughly ASP + 4.3% rather than ASP + 6%. ASP updated quarterly by CMS —
next update: July 1, 2026 for Q3.
Coverage
No NCD specific to ramucirumab. Coverage falls under MAC LCDs for chemotherapy + the generic drug coverage framework. All MACs cover J9308 for the four FDA-approved on-label indications with appropriate ICD-10 and clinical documentation. NCCN compendium support extends Medicare coverage to any additional NCCN-listed regimens.
Code history
- J9308 — permanent code, "Injection, ramucirumab, 5 mg"; effective since the 2015 HCPCS update following the April 2014 FDA approval. Prior to permanent assignment, ramucirumab was billed under unclassified J9999/C9399.
Patient assistance — Lilly Patient One Lilly verified May 2026
- Lilly Patient One: 1-866-472-8663 / lillypatientone.com — centralized Lilly oncology access program. Benefits investigation, prior authorization assistance, appeal support, copay assistance enrollment, free product evaluation.
- Cyramza Co-Pay Assistance Program: commercial copay support for eligible commercially-insured patients; excludes Medicare, Medicaid, TRICARE, and other federal program patients (federal anti-kickback statute).
- Lilly Cares Foundation Patient Assistance Program: free product for uninsured / underinsured patients meeting income thresholds (typically ≤ 500% FPL); 501(c)(3) foundation administered separately from Lilly commercial.
- Foundations (Medicare patients): PAN Foundation, HealthWell Foundation, CancerCare Co-Payment Assistance — verify open gastric, lung, colorectal, and HCC funds quarterly (funds open and close throughout the year).
- Web: lillypatientone.com · lillycares.com
Need to model what a specific patient will actually pay after copay assistance, deductible, coinsurance,
and OOP max? Run a CareCost Estimate — J9308 pre-loaded.
Phase 4
Fix problems
Missed JW, wrong dose for indication, missing AFP for HCC, and HTN/proteinuria documentation gaps are the top denials.
Common denials & how to fix them
| Denial reason | Common cause | Fix |
|---|---|---|
| JW waste line missing | Wasted units not reported on weight-based claim | Add JW line for discarded units. Both administered and discarded units pay at ASP+6%. CMS audit risk if omitted. |
| Wrong dose for indication | NSCLC patient billed at 8 mg/kg, or gastric patient billed at 10 mg/kg | Verify against chemo order. NSCLC = 10 mg/kg q3wk; gastric/mCRC/HCC = 8 mg/kg q2wk. Resubmit with corrected mg and matching unit count. |
| AFP not documented (HCC) | HCC PA submitted without AFP lab report | Submit AFP lab report showing ≥ 400 ng/mL within diagnostic workup. AFP ≥ 400 is FDA-label-required and payer-enforced. Without it, HCC claims will deny. |
| Prior sorafenib not documented (HCC) | HCC PA missing sorafenib history | Submit chart note showing prior sorafenib regimen, response, and reason for discontinuation (progression or toxicity). REACH-2 indication is second-line post-sorafenib. |
| Line of therapy not documented (gastric/NSCLC/mCRC) | PA without prior-regimen documentation | Gastric: prior platinum/fluoropyrimidine chart note. NSCLC: prior platinum chemo. mCRC: prior bevacizumab + oxaliplatin + fluoropyrimidine. |
| Combo agent PA missing | Concurrent PA on paclitaxel (gastric), docetaxel (NSCLC), or FOLFIRI (mCRC) not in place | Submit combo agent PA in parallel with Cyramza PA. Most payers require both before approving the regimen. |
| HTN / proteinuria monitoring not documented | Continuation PA submitted without BP log or UPCR/24-hr urine results | Submit cycle-by-cycle BP log and urine protein lab results. Withhold for UPCR ≥ 2 or BP not controlled; document dose holds and resumptions. |
| Wrong admin code (96365) | Therapeutic IV billed instead of chemo IV | Resubmit with 96413. Ramucirumab is HCPCS chemo-classified; chemo admin codes are correct. |
| Wrong NDC format (vial-level) | Vial NDC submitted instead of carton NDC with N4 qualifier | Use 11-digit carton NDC: 0002-7669-01 (100 mg) or 0002-7678-01 (500 mg) with N4 qualifier in 24A shaded area. |
| Site of care (HOPD) | HOPD administration on commercial plan with site-of-care UM | Move to office (POS 11) or AIC (POS 49). Submit medical-necessity letter if HOPD required. |
| Wound-healing / surgery hold not documented | Resumption after surgery without 28-day hold documentation | Document elective-surgery hold ≥ 28 days pre-op and ≥ 28 days post-op or until wound fully healed. Boxed warning — payers audit at renewal. |
Frequently asked questions
What is the HCPCS code for Cyramza?
Cyramza (ramucirumab) is billed under HCPCS J9308 — "Injection, ramucirumab, 5 mg."
The unit basis is 1 unit = 5 mg, NOT 1 mg. Convert milligrams to billing units by
dividing by 5: an 80 kg patient at 8 mg/kg = 640 mg = 128 units; the same patient at
10 mg/kg = 800 mg = 160 units.
Why does Cyramza use different doses for gastric vs NSCLC vs CRC vs HCC?
The four FDA-approved indications use indication-specific FDA-labeled doses validated in separate pivotal trials. Gastric/GEJ (single agent or with paclitaxel after platinum): 8 mg/kg IV q2wk (REGARD, RAINBOW). NSCLC (with docetaxel after platinum): 10 mg/kg IV q3wk (REVEL). mCRC (with FOLFIRI after bevacizumab/oxaliplatin/fluoropyrimidine): 8 mg/kg IV q2wk (RAISE). HCC (single agent, second-line post-sorafenib): 8 mg/kg IV q2wk (REACH-2). The dose and schedule are tied to the regimen — verify against the chemo order before billing.
What is the AFP threshold for Cyramza HCC coverage?
Cyramza is FDA-approved for HCC only in patients with serum AFP ≥ 400 ng/mL who have been previously treated with sorafenib. This is a biomarker gate — a documented AFP value at or above 400 ng/mL within the diagnostic workup is required by the FDA label and by Medicare and commercial payer policies. Without the AFP documentation, HCC claims will deny. The REACH-2 trial that supported this indication used the 400 ng/mL cutoff.
Which combination partners does Cyramza require by indication?
Gastric/GEJ: monotherapy OR with paclitaxel (post-platinum/fluoropyrimidine). NSCLC: with docetaxel (post-platinum). mCRC: with FOLFIRI (post-bevacizumab/ oxaliplatin/fluoropyrimidine). HCC: monotherapy (post-sorafenib, AFP ≥ 400). Each combination partner has its own HCPCS, its own PA, and its own claim line — do not bundle them under J9308.
Cyramza vs Avastin — different mechanism?
Both are anti-angiogenic monoclonal antibodies, but they bind different targets. Avastin (bevacizumab, J9035) binds VEGF-A ligand and blocks it from activating receptors. Cyramza (ramucirumab, J9308) binds the VEGFR2 receptor itself and blocks ligand binding. They are not interchangeable on the claim form, the codes are distinct, and the dosing/ indications differ. Avastin is approved across mCRC, NSCLC, GBM, mRCC, cervical, ovarian, and HCC; Cyramza is approved in gastric/GEJ, NSCLC, mCRC, and HCC — with the AFP ≥ 400 gate on HCC unique to Cyramza.
What HTN and proteinuria monitoring does Cyramza require?
Per FDA label, monitor blood pressure every 2 weeks during treatment; control hypertension before starting and during therapy. Withhold for severe hypertension until controlled. Monitor urine protein at baseline and periodically (typically every cycle); withhold for urine protein ≥ 2 g/24 hr (or UPCR ≥ 2) and resume at reduced dose when ≤ 2 g/24 hr; discontinue for nephrotic syndrome. Payer renewals and audits routinely request BP logs and UPCR/24-hr urine results.
Is Cyramza approved for pediatric use?
No. The safety and effectiveness of Cyramza have not been established in pediatric patients. There is no FDA-approved pediatric indication. Pediatric oncology use would be off-label and would require compendium or institutional rationale; expect non-coverage from most payers.
What administration CPT do I use for Cyramza?
CPT 96413 — "Chemotherapy administration, IV infusion technique; up to 1 hour, single
or initial substance/drug." Cyramza standard infusion is approximately 60 minutes,
fitting within the 1-hour 96413 window. Add 96415 only if total infusion runs over 1 hour.
For combo regimens (paclitaxel after Cyramza in gastric, docetaxel after Cyramza in NSCLC), add
96417 for the sequential second chemo agent. Do NOT bill 96365 — ramucirumab is
HCPCS chemo-classified.
How is Cyramza different from Cyramza-related biosimilars?
There are no FDA-approved ramucirumab biosimilars in the U.S. as of May 2026. Cyramza is a single-source product manufactured exclusively by Eli Lilly; all ramucirumab claims bill under J9308 with Lilly NDCs (0002-7669-01 or 0002-7678-01). There is no Q-code biosimilar pathway for payers to steer to. Compare with bevacizumab (Avastin J9035 + five biosimilars Q5107/Q5118/Q5126/Q5129/Q5145) where biosimilar substitution is payer-mandated.
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- FDA — CYRAMZA prescribing information (BLA 125477)
- DailyMed — CYRAMZA (ramucirumab solution)
- Lilly Oncology Support Center — Cyramza billing & coding guide
- Lilly Patient One
- CMS — Medicare Part B Drug ASP Pricing File
- SEER CanMED — HCPCS J9308 reference
- REGARD trial (Lancet 2014) — ramucirumab monotherapy in advanced gastric/GEJ cancer post-platinum
- RAINBOW trial (Lancet Oncology 2014) — ramucirumab + paclitaxel in advanced gastric/GEJ
- REVEL trial (Lancet 2014) — ramucirumab + docetaxel in second-line NSCLC
- RAISE trial (Lancet Oncology 2015) — ramucirumab + FOLFIRI in second-line mCRC
- REACH-2 trial (Lancet Oncology 2019) — ramucirumab in HCC with AFP ≥ 400 post-sorafenib
- NCCN Clinical Practice Guidelines — Gastric, NSCLC, Colon, Rectal, Hepatocellular Carcinoma
- UnitedHealthcare — Oncology Medication Clinical Coverage Policy
- Aetna Clinical Policy Bulletins — Antineoplastic agents
- CMS — JW/JZ modifier policy (CR 12056, eff. July 2023)
Refresh cadence
| Element | Cadence | How it's refreshed |
|---|---|---|
| Medicare ASP pricing | Quarterly | Auto-bound to CareCost ASP layer; updates on CMS file release. |
| Payer policies (UHC, Aetna, Cigna, BCBS) | Semi-annual | Manual review against published payer policy documents. |
| HCPCS / CPT / modifier rules | Annual | Reviewed against CMS HCPCS quarterly files and AMA CPT releases. |
| NDC, dosing, FDA label, indication list | Event-driven | Tied to manufacturer document version + FDA label revision date. |
Reviewer
Pending SME review. This page is staff-authored from primary sources (FDA, CMS,
manufacturer, payer documents — all linked above). Editorial review in progress. Until that review
is complete, treat this as a draft reference and verify each cited source for high-stakes claims.
Change log
- — Initial publication. ASP data: Q2 2026. Manufacturer source: Lilly Oncology Support Center 2026. Four FDA-approved indications (gastric/GEJ, NSCLC + docetaxel, mCRC + FOLFIRI, HCC post-sorafenib with AFP ≥ 400).
Methodology
Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical/pharmacy policy documents. Indication list and dosing are verified against the current FDA label revision. We do not paraphrase from billing-software vendor blogs.
Found an error? Email hello@carecostestimate.com.