Subcutaneous injection of amivantamab with hyaluronidase-lpuj, billed per 5 mg

This code represents the subcutaneous formulation of amivantamab co-formulated with hyaluronidase-lpuj, a bispecific antibody targeting EGFR and MET receptors used in the treatment of non-small cell lung cancer (NSCLC). The hyaluronidase component facilitates subcutaneous delivery by temporarily degrading hyaluronan in the subcutaneous matrix, enabling administration of larger volumes. This is distinct from the IV formulation of amivantamab (amivantamab-vmjw), as the subcutaneous route represents a separate drug product and billing unit.

This code applies when amivantamab with hyaluronidase-lpuj is administered subcutaneously for NSCLC with EGFR exon 20 insertion mutations, typically in combination with chemotherapy or as monotherapy in previously treated patients. Supporting documentation should include the confirmed EGFR mutation status (via molecular pathology report), the specific drug administered (brand name Rybrevant SC), dose in milligrams, and route of administration. Report units based on the total milligrams administered, with each unit representing 5 mg.

• Do not confuse with the IV amivantamab formulation (amivantamab-vmjw): The subcutaneous co-formulation with hyaluronidase is a distinct product; using the incorrect code may result in claim denial or audit risk.
• Unit calculation is critical: Doses are typically in the hundreds to over a thousand milligrams depending on body weight; divide the total administered dose by 5 to determine the number of billable units, and ensure the administered dose is clearly documented in the medical record.
• Verify payer-specific coverage policies: As a relatively new formulation, prior authorization requirements and medical necessity criteria (including EGFR exon 20 insertion confirmation) vary by payer; Medicare coverage may be addressed under a specific LCD or contractor policy.