ACCC

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Generic Name	Bleomycin sulfate
Payment Category	Medicare Part B
Year Introduced	1973
Type of Drug	Mixture of cytotoxic glycopeptide antibiotics
HCPCS	J9040
Billing Unit	15 units
Medicare Payment Limit (Effective January 1, 2021)	$27.01
FDA-Approved Indication(s) Palliative treatment (either as a single agent or in proven combinations) for 1) Squamous Cell Carcinoma of the head and neck (including mouth, tongue, tonsil, nasopharynx, oropharynx, sinus, palate, lip, buccal mucosa, gingivae, epiglottis, skin, larynx), penis, cervix, and vulva; 2) Hodgkin's Disease, non-Hodgkin's lymphoma; 3) Testicular Carcinoma (embryonal cell, choriocarcinoma, and teratocarcinoma). Also effective as a sclerosing agent for the treatment of malignant pleural effusion and prevention of recurrent pleural effusions. (5/10/10)
Approved Indication(s) with Orphan Drug Status	Treatment of malignant pleural effusion
ICD-10 Code(s) for Labeled Indication(s)	Malignant neoplasms of lip, oral cavity and pharynx [C00.xx through C14.xx, dependent on location]; Hodgkin lymphoma [C81.xx]; Non-Hodgkin's lymphomas [C82.xx through C85.xx]; Malignant neoplasm of testis [C62.x]; Malignant pleural effusion [J91.0]

Name	Strength	Form	Package	Labeler	NDC