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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

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