May 2025 Content Release Copied

05/22/20252025 ContentContent releasePhysician, Clinical, Admin, Billing

Clinical Profile Documentation

Problem Groups

Additions

The Problems > Add Details area is updated with applicable documentation points for the following diagnoses.

FOLR1 expression has been updated for Fallopian Tube Cancer and Ovarian and Primary Peritoneal Cancer with the following documentation points:

  • 2+ intensity AND >/=75%
  • 2+ intensity AND 50% – 74%
  • 2+ intensity AND 25% – 49%
  • <2+ intensity OR <25%
  • Unknown

NRAS status has been updated for Appendix Cancer, Carcinoma, Colon Cancer, Melanoma Skin, and Rectal cancers with the following documentation points:

  • Wild type
  • Mutation
  • Unknown

PD-L1 status has been updated for Bladder Cancer with the following documentation points:

  • Positive (>/= 5%)
  • Negative
  • Unknown

PD-L1 status has been updated for Breast Cancer with the following documentation points:

  • Positive (CPS >/= 10)
  • Negative
  • Unknown

PD-L1 status has been updated for Cervical Cancer and Head and Neck Cancer (Parent) with the following documentation points:

  • Positive (CPS >/= 1)
  • Negative
  • Unknown

PD-L1 status has been updated for Esophageal Cancer (Parent) and Gastric Cancer with the following documentation points:

  • CPS >/= 10
  • CPS 5-9
  • CPS 1-4
  • CPS 0
  • Unknown

PD-L1 status has been updated for Lung Cancer, Non-small Cell (NSCLC) with the following documentation points:

  • TPS >/= 50%
  • TPS 1-49%
  • Negative
  • Unknown

RET fusion status has been updated for Breast Cancer, Bile Duct Cancer, Cervical Cancer, Colon Cancer, Esophageal Cancer (Parent), Fallopian Tube Cancer, Gallbladder Cancer, Gastric Cancer, Hepatocellular Carcinoma (HCC), Lung Cancer, Non-small Cell (NSCLC), Neuroendocrine Tumor, Carcinoid (Parent), Ovarian and Primary Peritoneal Cancer, Pancreatic Cancer, Rectal Cancer, and Uterine Cancer, Sarcoma (Parent) with the following documentation points:

  • Positive
  • Negative
  • Other non-actionable finding
  • Unknown

ROS1 fusion status has been updated for Lung Cancer, Non-small Cell (NSCLC), Lung Cancer, Other, and Melanoma, Skin with the following documentation points:

  • Positive
  • Negative
  • Other non-actionable finding
  • Unknown

Lab Analytes & Panels

Additions/Updates

  • Acetylcholine receptor (AChR) antibodies, complete profile with reflex to musk antibodies panel
  • AChR binding Abs, serum, nmol/L
  • AChR blocking Abs, serum, %
  • AChR modulating Ab, %
  • Alpha-thalassemia analysis clinical information
  • Alpha-thalassemia analysis comments
  • Alpha-thalassemia analysis director review/release
  • Alpha-thalassemia analysis genes analyzed
  • Alpha-thalassemia analysis image
  • Alpha-thalassemia analysis indication
  • Alpha-thalassemia analysis interpretation
  • Alpha-thalassemia analysis methods/limitations
  • Alpha-thalassemia analysis panel
  • Alpha-thalassemia analysis recommendations
  • Alpha-thalassemia analysis references
  • Alpha-thalassemia analysis reflex testing
  • Alpha-thalassemia analysis result
  • Alpha-thalassemia analysis specimen type
  • ANA screen panel
  • Chlamydia by NAA
  • CLL minimal residual disease (CLL- MRD)
  • Copper, WB panel
  • Cortisol panel
  • Cortisol, plasma, ug/dL
  • Epstein barr ab IgG, IgGM panel
  • Factor IX (hemophilia B) genetic analysis panel
  • Footnotes
  • FoundationOne PD-L1 IHC (Dako 22C3 pharmDx) panel
  • FoundationOne Ventana FOLR1 (FOLR1-2.1) RxDx panel
  • Gonococcus by NAA
  • HBsAg screen
  • HCV Ab
  • Hep B core Ab, tot
  • Hep B surface Ab, qual
  • Hgb/Thal
  • Hgb/Thal clinical information
  • Hgb/Thal comments
  • Hgb/Thal genes analyzed
  • Hgb/Thal indication
  • Hgb/Thal methods/limitations
  • Hgb/Thal recommendations
  • Hgb/Thal result
  • Hgb/Thal specimen type
  • HIV Ab/p24 Ag screen
  • HPV SurePath genotype 16/18
  • HPV SurePath genotype 16/18 block ID
  • HPV SurePath genotype 16/18 H and E slide description
  • HPV SurePath genotype 16/18 HPV by ISH high risk
  • HPV SurePath genotype 16/18 HPV high risk comment
  • HPV SurePath genotype 16/18 source
  • IFE interpretation #2
  • IgA, immunoglobulin A (RDL) panel
  • IgA, immunoglobulin A (RDL), mg/dL
  • Interpretation
  • Interpretation PDF
  • Invitae cancer genetic risk panel
  • Invitae comprehensive genetic risk panel
  • JAK2 with reflex to exon 12, CALR and MPL panel
  • Liver cytosol (LC-1) Ab clinical relevance
  • Liver cytosol (LC-1) Ab disclaimer
  • Liver cytosol (LC-1) Ab electronically signed by
  • Liver cytosol (LC-1) Ab result
  • Liver cytosol (LC-1) Ab substrate
  • Manual diff verified by scan
  • MOG FACS, serum, qual
  • Multiple myeloma cascade panel
  • Multiple myeloma cascade reflex testing
  • PDF Image
  • Reflex information
  • Result
  • Rfx to HBc IgM
  • RPR
  • Rubeola IgG antibody, immune
  • Sexually transmitted infections (STI) profile, with CT/NG/TV NAA panel
  • Soluble liver antigen (SLA) IgG antibody panel
  • Thyroglobulin antibody and thyroglobulin panel
  • Thyroxine (T4) free, direct panel
  • Total protein, g/dL
  • Trich vag by NAA
  • TSH3-Ultra II, ulU/mL
  • Unsaturated iron binding capacity (UIBC) panel

Imaging

Additions/Updates

  • CT chest/abd w/ & w/o contrast
  • CT sinus w/ & w/o contrast
  • CT ankle, left w/ & w/o contrast
  • CT ankle, left w/ contrast
  • CT ankle, left w/o contrast
  • CT ankle, right w/ & w/o contrast
  • CT ankle, right w/ contrast
  • CT ankle, right w/o contrast
  • CT elbow, left w/ & w/o contrast
  • CT elbow, left w/ contrast
  • CT elbow, left w/o contrast
  • CT elbow, right w/ & w/o contrast
  • CT elbow, right w/ contrast
  • CT elbow, right w/o contrast
  • CT foot, left w/ & w/o contrast
  • CT foot, left w/ contrast
  • CT foot, left w/o contrast
  • CT foot, right w/ & w/o contrast
  • CT foot, right w/ contrast
  • CT foot, right w/o contrast
  • CT forearm, left w/ & w/o contrast
  • CT forearm, left w/ contrast
  • CT forearm, left w/o contrast
  • CT forearm, right w/ & w/o contrast
  • CT forearm, right w/ contrast
  • CT forearm, right w/o contrast
  • CT hand, left w/o contrast
  • CT hand, right w/o contrast
  • CT humerus, left w/ & w/o contrast
  • CT humerus, left w/ contrast
  • CT humerus, left w/o contrast
  • CT humerus, right w/ & w/o contrast
  • CT humerus, right w/ contrast
  • CT humerus, right w/o contrast
  • CT knee, left w/ & w/o contrast
  • CT knee, left w/ contrast
  • CT knee, left w/o contrast
  • CT knee, right w/ & w/o contrast
  • CT knee, right w/ contrast
  • CT knee, right w/o contrast
  • CT shoulder, left w/ & w/o contrast
  • CT shoulder, right w/ & w/o contrast
  • CT tib/fib, left w/ & w/o contrast
  • CT tib/fib, left w/ contrast
  • CT tib/fib, left w/o contrast
  • CT tib/fib, right w/ & w/o contrast
  • CT tib/fib, right w/ contrast
  • CT tib/fib, right w/o contrast
  • CT wrist, left w/ & w/o contrast
  • CT wrist, left w/ contrast
  • CT wrist, left w/o contrast
  • CT wrist, right w/ & w/o contrast
  • CT wrist, right w/ contrast
  • CT wrist, right w/o contrast

Medications

Additions

  • 225Ac Ac-PSMA-617 invest IV
  • AAA817 invest (225Ac Ac-PSMA-617 invest IV)
  • Compounded CSF Insufflation Powder Otic
  • Elranatamab invest Subcutaneous
  • GDC-7035 invest Oral
  • IPN01195 invest Oral
  • JSB462 invest Oral
  • Libido LC Compounded Topical Cream
  • Luxdegalutamide invest (JSB462 invest Oral)
  • ORIC-944 invest Oral
  • Simplified Magic Mix (Maalox-Lidocaine) Oral
  • TNG260 invest Oral
  • WSD0922-FU invest Oral

Updates

Medications Updates
68Ga-PSMA-11 invest IV New Drug Name available:

  • Gallium [68Ga] Gozetotide or [68Ga]Ga-PSMA-11 invest IV

New Alias Name available:

  • AAA517 invest (Gallium 68Ga Gozetotide or 68Ga Ga-PSMA-11 invest IV)
AB680 invest IV New Unit available:

  • mL
Adcetris (Brentuximab Vedotin IV) New Weight Cap of 100 kg set for the following formula dosage:

  • Brentuximab Vedotin 0 mg/kg intravenously Piggyback every 2 weeks
  • Brentuximab Vedotin 0 mg/kg intravenously Piggyback every 3 weeks
  • Brentuximab Vedotin 0.9 mg/kg intravenously Piggyback once
  • Brentuximab Vedotin 1.2 mg/kg intravenously Piggyback once
  • Brentuximab Vedotin 1.5 mg/kg intravenously Piggyback once
  • Brentuximab Vedotin 1.8 mg/kg intravenously Piggyback once
Brentuximab vedotin invest (SGN-35 invest IV) New Weight Cap of 100 kg set for the following formula dosage:

  • 1.8 mg/kg intravenously once
Carfilzomib invest IV New BSA Cap of 2.2 m2 set for the following formula dosage:

  • 20 mg/m2 intravenously once
  • 56 mg/m2 intravenously once
  • 70 mg/m2 intravenously once
Dato-DXd (datopotamab deruxtecan; DS-1062a)

invest (DS-1062a invest IV)

 New Weight Cap of 90 kg set for the following formula dosage:
6 mg/kg intravenously every 3 weeks; Over 90 min for C1D1, then may decrease to 30 min thereafter.
Datroway (datopotamab deruxtecan-dlnk IV) New BSA Cap of 90 kg set for the following formula dosage:

  • datopotamab deruxtecan-dlnk 3 mg/kg intravenously Piggyback every 3 weeks
  • datopotamab deruxtecan-dlnk 4 mg/kg intravenously Piggyback every 3 weeks
  • datopotamab deruxtecan-dlnk 6 mg/kg (not to exceed 540 mg) intravenously Piggyback every 3 weeks
  • datopotamab deruxtecan-dlnk 6 mg/kg intravenously Piggyback once
Enfortumab vedotin invest (ASG-22CE invest IV) New Weight Cap of 100 kg set for the following formula dosage:

  • 1.25 mg/kg intravenously As Directed
Enfortumab vedotin-ejfv IV New Weight Cap of 100 kg set for the following formula dosage:

  • Enfortumab Vedotin-ejfv 0 mg/kg intravenously As Directed
  • Enfortumab Vedotin-ejfv 0.5 mg/kg (not to exceed 50 mg) intravenously Piggyback every week; administer over 30 mins on days 1 and 8 of a 21 day cycle; quantity sufficient for 2 weeks
  • Enfortumab Vedotin-ejfv 0.5 mg/kg intravenously Piggyback once; administer over 30 minutes; Dosage based on ACTUAL body weight with maximum dose not to exceed 50 mg.
  • Enfortumab Vedotin-ejfv 0.75 mg/kg (not to exceed 75 mg) intravenously Piggyback every week; administer over 30 mins on days 1 and 8 of a 21 day cycle; quantity sufficient for 2 weeks
  • Enfortumab Vedotin-ejfv 0.75 mg/kg intravenously Piggyback once; administer over 30 minutes; Dosage based on ACTUAL body weight with maximum dose not to exceed 75 mg.
  • Enfortumab Vedotin-ejfv 1 mg/kg (not to exceed 100 mg) intravenously Piggyback every week; administer over 30 mins on days 1 and 8 of a 21 day cycle; quantity sufficient for 2 weeks
  • Enfortumab Vedotin-ejfv 1 mg/kg intravenously Piggyback once; administer over 30 minutes; Dosage based on ACTUAL body weight with maximum dose not to exceed 100 mg.
  • Enfortumab Vedotin-ejfv 1.25 mg/kg (not to exceed 125 mg) intravenously Piggyback every week; administer over 30 mins on days 1 and 8 of a 21 day cycle; quantity sufficient for 2 weeks
  • Enfortumab Vedotin-ejfv 1.25 mg/kg intravenously Piggyback once; administer over 30 minutes; Dosage based on ACTUAL body weight with maximum dose not to exceed 125 mg.
Ixabepilone IV New BSA Cap of 2.2 m2 set for the following formula dosage:

  • Ixabepilone 24 mg/m2 intravenously Piggyback every 3 weeks
  • Ixabepilone 24 mg/m2 intravenously Piggyback once
  • Ixabepilone 32 mg/m2 intravenously Piggyback every 3 weeks
  • Ixabepilone 32 mg/m2 intravenously Piggyback once
  • Ixabepilone 40 mg/m2 intravenously Piggyback every 3 weeks
  • Ixabepilone 40 mg/m2 intravenously Piggyback once
Kyprolis (Carfilzomib IV) New BSA Cap of 2.2 m2 set for the following formula dosage:

  • Carfilzomib 20 mg/m2 intravenously Piggyback once
  • Carfilzomib 27 mg/m2 intravenously Piggyback once
  • Carfilzomib 36 mg/m2 intravenously Piggyback once
  • Carfilzomib 45 mg/m2 intravenously Piggyback once
  • Carfilzomib 56 mg/m2 intravenously Piggyback once
  • Carfilzomib 70 mg/m2 intravenously Piggyback once
LY3537982 invest Oral New Alias Name available:

  • Olomorasib invest
Slow Fe (Ferrous Sulfate Oral ER Tab) New default Form available to match with the default SIG:

  • 142 mg (45 mg iron) tablet extended release
TAK-079 invest Subcutaneous Updated Form available:

  • 150 mg/mL soln 2 mL vials/kit
Tisotumab Vedotin-tftv IV New Weight Cap of 100 kg set for the following formula dosage:

  • Tisotumab Vedotin-tftv 0.9 mg/kg intravenously Piggyback As Directed; administer over 30 minutes
  • Tisotumab Vedotin-tftv 0.9 mg/kg intravenously Piggyback every 3 weeks; administer over 30 minutes
  • Tisotumab Vedotin-tftv 0.9 mg/kg intravenously Piggyback once; administer over 30 minutes
  • Tisotumab Vedotin-tftv 1.3 mg/kg intravenously Piggyback As Directed; administer over 30 minutes
  • Tisotumab Vedotin-tftv 1.3 mg/kg intravenously Piggyback every 3 weeks; administer over 30 minutes
  • Tisotumab Vedotin-tftv 1.3 mg/kg intravenously Piggyback once; administer over 30 minutes
  • Tisotumab Vedotin-tftv 2 mg/kg intravenously Piggyback As Directed; administer over 30 minutes
  • Tisotumab Vedotin-tftv 2 mg/kg intravenously Piggyback every 3 weeks; administer over 30 minutes
  • Tisotumab Vedotin-tftv 2 mg/kg intravenously Piggyback once; administer over 30 minutes
Trifluridine-Tipiracil Oral 15 mg-6.14 mg New default SIG available:

  • 35 mg/m2 (not to exceed 80 mg) orally (of trifluridine) 2 times per day; must administer with food (with morning and evening meals); on Days 1 through 5 and Days 8 through 12 of 28-day cycle

Regimen Library

Additions

Regimen Name Diagnosis
Anastrozole + Goserelin Q3M (5 years) Breast Cancer
Capecitabine D1-14 + Cisplatin + Tislelizumab-jsgr Q21D Esophageal Cancer (Parent)
Capecitabine D1-14 + Oxaliplatin (XELOX/CAPOX) + Tislelizumab-jsgr Q21D Esophageal Cancer (Parent)
Capecitabine D1-15 + Oxaliplatin (XELOX/CAPOX) + Cetuximab D1,8,15 Q21D Colon Cancer; Rectal Cancer
Exemestane + Goserelin Q3M (5 years) Breast Cancer
Fluorouracil CIV + Leucovorin + Oxaliplatin D1,15,29 + Tislelizumab-jsgr D1,22 Q42D Esophageal Cancer (Parent); Gastric Cancer
Fluorouracil CIV D1-5 + Cisplatin + Tislelizumab-jsgr Q21D Esophageal Cancer (Parent); Gastric Cancer
Fluorouracil (Bolus + CIV) D1-2 + Leucovorin + Oxaliplatin (FOLFOX 6, Modified) D1,15 + Panitumumab D1,15 + Encorafenib Q28D Colon Cancer; Rectal Cancer
Goserelin Q3M (Breast) Breast Cancer
Intrathecal Topotecan Q14D (Maintenance 1) Brain Tumor (Parent)
Letrozole + Goserelin Q3M (5 years) Breast Cancer
Oxaliplatin + Paclitaxel + Tislelizumab-jsgr Q21D Esophageal Cancer (Parent)
Pacritinib + Darbepoetin alfa D1,8,15,22 Q28D (Myelofibrosis) Myelofibrosis; Myeloproliferative Disorder
Pacritinib + Epoetin alfa D1,8,15,22 Q28D (Myelofibrosis) Myelofibrosis; Myeloproliferative Disorder
Pacritinib + Luspatercept-aamt Q21D (Myelofibrosis) Myelofibrosis; Myeloproliferative Disorder
Paclitaxel + Cisplatin + Tislelizumab-jsgr Q21D Esophageal Cancer (Parent)
Talquetamab-tgvs (Talvey) SQ + Teclistamab- cqyv (Tecvayli) SQ D1,4,7,15,22 fb D1,8,15,22 fb D1,15 Q28D Multiple Myeloma (MM)
Tamoxifen + Goserelin Q3M (5 years) Breast Cancer

Updates

Regimens for the following diagnoses have been updated based on the Collaborative Care Committee voting. Changes include but are not limited to reference update, drug infusion instruction updates, renaming of regimens, premedication template updates and number of cycles.

  • All Problems
  • Anal Cancer (Parent)
  • Bile Duct Cancer (Parent)
  • Breast Cancer
  • Colon Cancer
  • Esophageal Cancer (Parent)
  • Fallopian Tube Cancer
  • Gallbladder Cancer
  • Gastric Cancer
  • Hemolytic Uremic Syndrome
  • Hepatocellular Carcinoma (HCC)
  • Lung Cancer, Non-small Cell (NSCLC)
  • Lung Cancer, Small Cell (SCLC)
  • Lymphoma, Non-Hodgkin (NHL) (Parent)
  • Melanoma, Skin
  • Melanoma, Uvea, Ciliary Body/Choroid
  • Myasthenia Gravis
  • Neuroendocrine Tumor, Carcinoid (Parent)
  • Ovarian and Primary Peritoneal Cancer
  • Pancreatic Cancer, Carcinoid/Neuroendocrine
  • Paroxysmal Nocturnal Hemoglobinuria
  • Rectal Cancer
  • Renal Cell Carcinoma (RCC)
  • Uterine Cancer (Parent)
  • Waldenstrom’s Macroglobulinemia

Renames

Previous Name New Name
Immunotherapy-Related Toxicity Supportive Care Immunotherapy-Related Toxicity Supportive Care (Infliximab, Vedolizumab, Corticosteroids)
Nivolumab D1,15,29 + Ipilimumab Q42D

(Perioperative Esophageal, Gastric)

 Nivolumab D1,15,29 + Ipilimumab Q42D (Esophageal, Gastric)
Osimertinib + Pemetrexed + Carboplatin Q21D Osimertinib + Pemetrexed + Carboplatin Q21D fb Osimertinib + Pemetrexed Q21D Maintenance
Osimertinib + Pemetrexed + Cisplatin Q21D Osimertinib + Pemetrexed + Cisplatin Q21D fb Osimertinib + Pemetrexed Q21D Maintenance
Polatuzumab vedotin D1 + Rituximab IV D2 + CHP D2 Q21D (6 cycles) (Immunotherapy Split) fb Rituximab IV Q21D (2 cycles) Polatuzumab vedotin D2 + Rituximab IV D1 + CHP D1 Q21D (6 cycles) (Immunotherapy Split) fb Rituximab IV Q21D (2 cycles)

Billing & HCPCS Codes

Updates

Medication HCPCS Codes
Ceftobiprole IV J3490 per 667 mg
Efgartigimod-Hyaluronidas-qvfc Subcutaneous J9334 per 5 mL
Epinephrine IM J3490 per 0.3 mg
Epinephrine IV J3490 per 1 mg
Epinephrine Subcutaneous J3490 per 0.01 mg
Foscarbidopa-Foslevodopa Continuous Subcutaneous Infusion J3490 per 10 mL
Foscarbidopa-Foslevodopa Subcutaneous J3490 per 10 mL
Ocrelizumab-Hyaluronidase-ocsq Subcutaneous 920 mg-23,000 unit/23 mL J2351 per 0.025 mL
Piperacillin-Tazobactam IV J2543 per 1.125 g
Remestemcel-L-rknd IV J3590 per 2 x 10e6 MSCs
Sildenafil IV J3490 per 0.8 mg

NDC – HCPCS Crosswalk

Additions

Medication (Brand) HCPCS Codes NDC
Efgartigimod-Hyaluronidas-qvfc subcutaneous J9334 73475122101
73475122101
Foscarbidopa-Foslevodopa Subcutaneous J3490 00074050101
Foscarbidopa-Foslevodopa Continuous Subcutaneous Infusion J3490 00074050101