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November 8, 2021

Qutenza (capsaicin 8% topical system) Billing and Coding Instruction Article

Qutenza® is indicated for the management of neuropathic pain associated with post-herpetic neuralgia and diabetic peripheral neuropathy.

Coding for Qutenza

CPT code:

  • 64999 Unlisted procedure, nervous system

HCPCS:

  • J7336 Capsaicin 8% patch, per 1 square centimeters

ICD-10 codes associate with ICD-10 code aligned with FDA labeled use for this product such as:

  • B02.23 - Postherpetic polyneuropathy
  • B02.29 - Other postherpetic nervous system involvement (postherpetic radiculopathy)
  • E10.40 - Type 1 diabetes mellitus with diabetic neuropathy, unspecified
  • E10.41 - Type 1 diabetes mellitus with diabetic mononeuropathy
  • E10.42 - Type 1 diabetes mellitus with diabetic polyneuropathy
  • E11.40 - Type 2 diabetes mellitus with diabetic neuropathy, unspecified
  • E11.41 - Type 2 diabetes mellitus with diabetic mononeuropathy
  • E11.42 - Type 2 diabetes mellitus with diabetic polyneuropathy

Unlabeled use of this drug is subject to review on case-by-case basis, and will be required to meet the reasonable and necessary criteria for off-label use as described in the Medicare Benefit Policy Manual Chapter 15, Section 50.4.2, Unlabeled Use of DrugExternal pdf.

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