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Healthcare Common Procedure Coding System (HCPCS)* J-Code for ELREXFIO (elranatamab-bccm) injection:

Effective for dates of service on or after April 1, 2024, the Centers for Medicare and Medicaid Services (CMS) has assigned the following Healthcare Common Procedure Coding System (HCPCS)* J-Code for ELREXFIO (elranatamab-bccm) injection:

J1323- Injection, elranatamab-bcmm, 1 mg

Please see full prescribing information including Boxed Warning, HERE.

Permanent J-Code Announcement

G1 Therapeutics, Inc. secures permanent J Code for COSELA™ (trilaciclib). The code, J1448, is effective on October 1, 2021. Visit COSELA.com for more information. 

New Permanent J-Code for Melphalan Flufenamide

Oncopeptides announces J-code J9247 for Pepaxto® (melphalan flufenamide) injection, 1mg. This J-code will be effective on October 1, 2021. 

A product-specific J-code for an mUC treatment is now available

Astellas announces the assignment of a product-specific, permanent J-code for PADCEV. The Centers for Medicare & Medicaid Services (CMS) released the July 2020 Quarterly Healthcare Common Procedural Coding System (HCPCS) File, which includes the designation ofJ9177 for PADCEV with the effective date of July 1, 2020.1

Trade Name Strength2 NDC2 HCPCS Code1 CMS Long Descriptor1 PADCEV 20 mg 51144-0020-01* J9177 Injection, enfortumab vedotin-ejfv, 0.25 mg† PADCEV 30 mg 51144-0030-01*

*

Note that the product’s NDC code has been “zero-filled” to ensure creation of an 11-digit code that meets HIPAA standards.3 The zero-fill location is indicated in bold. Dose descriptor is provided as the smallest amount that can be billed in multiple units in order to accommodate a variety of doses.1 HIPAA, Health Insurance Portability and Accountability Act; NDC, National Drug Code.

ENHERTU® (fam-trastuzumab deruxtecan-nxki) has been assigned a unique HCPCS code by the Centers for Medicare & Medicaid Services (CMS).

 Effective for dates of services on or after July 1, 2020, the following code can be used to identify ENHERTU® (fam-trastuzumab deruxtecan-nxki) when billing across settings of care as noted in the CMS HCPCS Application Summaries and Coding Decisions - First Quarter, 2020 Coding Cycle for Drug and Biological Products available [here].

 

Code	Description	Vial Size	Billing Units	NDC
J9358	Injection, fam-trastuzumab deruxtecan-nxki, 1mg1	100 mg	100 units	65597-406-01

 

The suggestion contained in this resource is for example only. AstraZeneca/Daiichi Sankyo makes no representation that the information is accurate or that it will comply with the requirements of any particular payer/insurer. Providers are solely responsible for determining the billing and coding requirements applicable to any payer/insurer. The information provided here is not intended to be conclusive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. No warranties or guarantees, expressed or implied, are made concerning the accuracy or appropriateness of this information for your particular use. The use of this information does not guarantee payment or that any payment received will cover your costs.

ADAKVEO® (crizanlizumab-tmca) J-code J0791 effective 7/1/2020

Permanent J-code for POLIVY™ (polatuzumab vedotin-piiq

The Centers for Medicare & Medicaid Services (CMS) has assigned a permanent J-code for POLIVY™ (polatuzumab vedotin-piiq). POLIVY received FDA approval on June 10, 2019. Effective January 1, 2020, the J-code is J9309 (Injection, polatuzumab vedotin-piiq, 1 mg).

For dates of service on or after July 1, 2020, the Centers for Medicare and Medicaid Services (CMS) has issued a product-specific J-code: J0791 for injection, crizanlizumab-tmca, 5 mg. The updated billing unit is 5 mg.

The new and unique J-code replaces all previous HCPCS codes for ADAKVEO® (crizanlizumab-tmca) for IV Infusion 10 mg/mL. The permanent J-code is used by all payer types.

Please note: For dates of service before July 1, 2020, use either J3490 (unclassified drugs, all sites of care) or J3590 (unclassified biologics, all sites of care). For dates of service between April 1, 2020, and June 30, 2020, some payers may allow the use of C9053 (Injection, crizanlizumab-tmca, 1 mg, Hospital outpatient).

 

ADAKVEO is supplied as a solution in a single-dose vial. See below for coding details:

 

Unique J-code for ADAKVEO	Description	Vial size	Billing unit
J0791	Injection, crizanlizumab-tmca, 5 mg	100 mg/10 mL (10 mg/mL)	20

 

• 1 unit = 5 mg

• The JW modifier must be used to report the amount of drug in single-dose or single-use packaging that is discarded and eligible for payment.

 

Permanent J-code for Herceptin HYLECTA™ (trastuzumab and hyaluronidase-oysk)

The Centers for Medicare & Medicaid Services (CMS) has made a change to the Herceptin HYLECTA™ (trastuzumab and hyaluronidase-oysk) J-code and has assigned a permanent J-code. Effective July 1, 2019 the permanent J-code for Herceptin HYLECTA is J9356.

New UDENYCA™ (pegfilgrastim-cbqv) Q-code Assigned

A newly assigned Q-code that was announced by CMS in their HCPCS Quarterly Update on Wednesday, November 21, 2018.  The newly assigned code is effective January 1, 2019.

 NGS Coverage Information

HCPCS/MOD Code	Action	Long Descriptor	Short Descriptor
Q5111	ADD	Injection, Pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg.	Injection, udenyca, 0.5 mg

CMS announces a new permanent J-code for AKYNZEO® (fosnetupitant and palonosetron) for injection, for intravenous use. The Centers for Medicare & Medicaid Services (CMS) released the 2019 Alpha-Numeric HCPCS File, which included the designation of J1454 - Injection, fosnetupitant 235 mg and palonosetron 0.25 mg for AKYNZEO® for injection with the effective date of January 1, 2019.¹

 

Trade Name	HCPCS Code – CMS Long Descriptor	NDC2	Effective Date
AKYNZEO® (fosnetupitant and palonosetron), for injection, for intravenous use	J1454 Injection, fosnetupitant 235 mg and palonosetron 0.25 mg	69639-0102-01*	January 1, 2019

*Note that the product’s NDC code has been “zero‐filled” to ensure creation of an 11‐digit code that meets HIPAA standards.

The zero‐fill location is indicated in bold. HCPCS=Healthcare Common Procedure Coding System; NDC=National Drug Code.

 

The new intravenous formulation, AKYNZEO® (fosnetupitant and palonosetron) for injection, was approved on April 19, 2018 by the U.S. Food and Drug Administration.³

Permanent J-code for RITUXAN HYCELA

The Centers for Medicare & Medicaid Services (CMS) has made a change to the RITUXAN® (rituximab) J-code and has assigned a permanent J-code for RITUXAN HYCELA® (rituximab/hyaluronidase human subcutaneous injection). Effective January 1, 2019 J-code J9312 will replace J9310 for RITUXAN and the billable units will change from 100 mg to 10 mg. Additionally, the permanent J-code assigned for RITUXAN HYCELA is J9311.

Four New ICD-10-CM Diagnosis Codes for Merkel Cell Carcinoma

CMS has revised the C4A range of ICD-10-CM diagnosis codes to add the following four new codes effective for dates of service on or after October 1, 2018[1].  

C4A.111	Merkel cell carcinoma of right upper eyelid, including canthus
C4A.112	Merkel cell carcinoma of right lower eyelid, including canthus
C4A.121	Merkel cell carcinoma of left upper eyelid, including canthus
C4A.122	Merkel cell carcinoma of left lower eyelid, including canthus

 

 

 

 

 

 

 The full range of C4A ICD-10-CM diagnosis codes is included in the 2019 ICD-10-CM files at the following link: https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html

Unique C-code for RITUXAN HYCELA™ (rituximab/hyaluronidase human)

A unique C-code that was recently assigned to RITUXAN HYCELA™ (rituximab/hyaluronidase human) by the Centers for Medicare & Medicaid Services (CMS). The C-code for RITUXAN HYCELA is C9467 (Injection, rituximab and hyaluronidase, 10 mg).

The unique C-code went into effect on April 1, 2018. Payers may require its use until a permanent J-code is assigned. The permanent J-code is expected to be available for use starting on January 1, 2019.

The C-code is used primarily in the Medicare hospital outpatient setting. Please check with your MAC to verify codes and any special billing requirements.

Product-specific Q code for YESCARTA® (axicabtagene ciloleucel).

The new code, Q2041, is defined as “Axicabtagene Ciloleucel, up to 200 million autologous Anti-CD19 CAR T Cells, Including leukapheresis and dose preparation procedures, per infusion.”  This code will be effective April 1, 2018.

^{https://www.yescarta.com/wp-content/uploads/yescarta-pi.pdf}

Effective for dates of service on or after January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) has granted the following Healthcare Common Procedure Coding System (HCPCS) codes for  the Medicare Outpatient Prospective Payment System (OPPS):

 

• MYLOTARG J-Code: J9203 – injection, gemtuzumab ozogamicin, 0.1 mg

 

The J-code will be able to be reported for both the physician office and outpatient hospital settings, and for both Medicare and non-Medicare payers. In addition, CMS has granted transitional pass-through status for MYLOTARG for the Medicare outpatient hospital setting (OPPS), which is also effective January 1, 2018.  Having pass-through status ensures that MYLOTARG will be paid at ASP+6% (subject to sequestration) under the OPPS for the next 2-3 years. The existing J-code for Mylotarg (J9300) will be deleted at the end of this year.

 

• BESPONSA C-Code: C9028 – injection, inotuzumab ozogamicin, 0.1 mg

 

This temporary C-code is specific to inotuzumab and is only for use on Medicare hospital outpatient claims; C-codes cannot be used in the physician office setting.  Additionally, private commercial payers and state Medicaid programs have the discretion to accept C-codes but are not required to use them. Reimbursement for covered Medicare OPPS claims will be based on the ASP+6% payment methodology effective, January 1, 2018 (subject to sequestration).  Medicare Part B claims in the physician office setting of care will continue to be submitted with “Not Otherwise Classified” (NOC) HCPCS codes for 2018 (until the J-code is issued for 2019).   NOC codes also will need to be used for any non-Medicare payers that do not accept C-codes.

New Permanent J- code for LARTRUVO^TM (olaratumab) injection.

The new code, J9285, is defined as “injection, olaratumab, 10 mg.” This code is effective January 1, 2018.¹

Trade Name	HCPCS Code	CMS Long Descriptor	Strength	NDC	Effective Date
LARTRUVO	J9285	Injection, olaratumab, 10 mg	500 mg/50 mL (10 mg/mL)	00002-8926-01*	January 1, 2018
190 mg/19 mL (10 mg/mL)	00002-7190-01*

 *Note that the product’s NDC code has been “zero‐filled” to ensure creation of an 11‐digit code that meets HIPAA standards. The zero‐fill location is indicated in bold.

HCPCS= Healthcare Common Procedure Coding System; NDC=National Drug Code; HIPAA=Health Insurance Portability and Accountability Act.

 For more information, please visit www.LARTRUVO.com/HCP.

New permanent J-Code for BAVENCIO^® (avelumab) Injection effective January 1, 2018.

The permanent J-code for BAVENCIO J9023 (injection, avelumab, 10mg) (1)

Healthcare provider and patient questions related to BAVENCIO reimbursement may be directed to CoverOne^® at 844-8COVER1 (844-826-8371) or CoverOne.com.  CoverOne^® provides patient access and reimbursement support services to help patients gain appropriate access to BAVENCIO.

 Full Prescribing Information for BAVENCIO: https://www.bavencio.com/en_US/document/Prescribing-Information.pdf

[1] Centers for Medicare and Medicaid Services, 2018 Alpha-numeric Healthcare Common Procedure Coding System file, November 2017. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html

New permanent J-code for TECENTRIQ® (atezolizumab) effective January 1, 2018

The permanent J-code for TECENTRIQ is J9022 (injection, atezolizumab, 10 mg). The J-code goes into effect on January 1, 2018. Please check with your payers to verify codes and special billing requirements. Also, please be sure to prepare your systems as appropriate for the introduction of this new permanent J-code.

Contact Genentech Access Solutions for TECENTRIQ at (888) 249-4918 Monday through Friday, 6 a.m.-5 p.m. PT, or visit Genentech-Access.com/TECENTRIQ for more information. 

New J-code for ONIVYDE^® (irinotecan liposome injection), effective January 1, 2017. 

https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html                     

J9205, Injection, irinotecan liposome, 1 mg.

HCPCS Code	Description	Billing Unit	Effective Date
J9205	Injection, irinotecan liposome, 1 mg	1 mg	January 1, 2017

Permanent HCPCS code for IMLYGIC^® (talimogene laherparepvec).

The Centers for Medicare & Medicaid Services (CMS) has assigned a permanent Healthcare Common Procedure Coding System (HCPCS) code specific to IMLYGIC^® (talimogene laherparepvec).

The new code, J9325, is defined as “injection, talimogene laherparepvec, per 1 million plaque forming units.” This code is effective January 1, 2017¹.

IMLYGIC was the first oncolytic virus approved by the U.S. Food and Drug Administration on October 27, 2015².  IMLYGIC is a genetically modified oncolytic viral therapy indicated for the local treatment of unresectable cutaneous, subcutaneous, and nodal lesions in patients with melanoma recurrent after initial surgery.  IMLYGIC has not been shown to improve overall survival or have an effect on visceral metastases.

Trade Name	HCPCS Code	Strength3	NDC3	Effective Date
IMLYGIC	J9325 injection, talimogene laherparepvec, per 1 million plaque forming units (PFU)	106 (1 million) PFU per mL   108 (100 million) PFU per mL	55513-078-01   55513-079-01	January 1, 2017

New HCPCS Code for Portrazza® (necitumumab) for injection

The new code, J9295, is defined as “injection, necitumumab, 1 mg.” This code is effective January 1, 2017.¹   

 

Trade Name	HCPCS Code	Strength	NDC*	Effective Date
Portrazza	J9295 injection, necitumumab, 1 mg	800 mg/50 mL (16 mg/mL)	00002-7716-01	January 1, 2017

*Note that the product’s NDC code has been “zero‐filled” to ensure creation of an 11‐digit code that meets CMS standards.

The zero‐fill location is indicated in bold. 
NDC=National Drug Code.

Portrazza was approved by the US Food and Drug Administration on November 24, 2015. Portrazza is an epidermal growth factor receptor (EGFR) antagonist indicated, in combination with gemcitabine and cisplatin, for first-line treatment of patients with metastatic squamous non-small cell lung cancer (NSCLC). Portrazza is not indicated for the treatment of nonsquamous NSCLC.

Permanent J code for BENDEKA

On November 1st 2016, the Center for Medicare and Medicaid Services (CMS) published the 2017 HCPCS Code set, which included a permanent, UNIQUE J code for BENDEKA® (bendamustine HCI) Injection.

Effective January 1, 2017, the Permanent J code for BENDEKA® will be J 9034 Injection, bendamustine HCI (bendeka), 1 mg.

The published information by CMS can be found in this link:

https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS-Items/2017-Alpha-Numeric-HCPCS-File.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending

Select “2017 Alpha-Numeric HSPCS file” and refer to line 4198 in the Excel worksheet.

Payers and Providers are encouraged to update all medical & billing systems prior to December 31, 2016 with this new information.

New CPT Code for Neulasta® (pegfilgrastim) Onpro®

The American Medical Association (AMA) has issued a new CPT code, 96377, “application of on-body injector (includes cannula insertion) for timed subcutaneous injection,” effective January 1, 2017.1,2 This new code may be used by providers to describe the physician services associated with the Neulasta® (pegfilgrastim) Onpro®. The Centers for Medicare and Medicaid Services (CMS) has not yet set a national payment rate for the new code in the clinic setting. CMS is addressing CY 2017 payment for the code in the hospital outpatient setting nationally through rulemaking. Therefore, it is expected that the new code will be contractor priced for 2017 in the clinic setting. Amgen believes that commercial payors should crosswalk the CY 2017 payment rate for this new code to the payment rate of CPT code 96372 [Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular].

C-Code for TECENTRIQ

Effective October 1, 2016, 

A unique C-code that was recently assigned to TECENTRIQ™ (atezolizumab) by the Centers for Medicare & Medicaid Services (CMS). The C-code for TECENTRIQ is C9483 (Injection, atezolizumab, 10 mg).

The unique C-code goes into effect on October 1, 2016. Payers may require its use until a permanent J-code is assigned. The permanent J-code is expected to be available for uses starting on January 1, 2018.

The C-code is used primarily in the Medicare hospital outpatient setting. However, some payers accept this C-code instead of unclassified J- or C-codes when billing for TECENTRIQ. Please check with your payers to verify codes and special billing requirements.

C-code for Portrazza

A product‐specific C‐code has been assigned for Portrazza® (necitumumab) injection. The Centers for Medicare & Medicaid Services (CMS) released the April 2016 Update of the Hospital Outpatient Prospective Payment System (OPPS), which included designation of C9475 for Portrazza with the effective date of April 1, 2016.

Trade Name	HCPCS Code	Strength	NDC	CMS Long Descriptor	Effective Date
Portrazza	C9475	800 mg/50 mL (16 mg/mL)	00002-7716-01*	Injection, necitumumab, 1mg	April 1, 2016

*Note that the product’s NDC code has been “zero‐filled” to ensure creation of an 11‐digit code that meets CMS standards.

The zero‐fill location is indicated in bold.

HCPCS=Healthcare Common Procedure Coding System; NDC=National Drug Code.

Portrazza was approved by the US Food and Drug Administration on November 24, 2015. Portrazza is an epidermal growth factor receptor (EGFR) antagonist indicated, in combination with gemcitabine and cisplatin, for first-line treatment of patients with metastatic squamous non-small cell lung cancer (NSCLC). Portrazza is not indicated for the treatment of nonsquamous NSCLC.

PROLONGED DRUG AND BIOLOGICAL INFUSIONS STARTED INCIDENT TO A PHYSICIAN'S SERVICE USING AN EXTERNAL PUMP

This article is intended to provide the coding direction allowed to the MAC in MLN Matters^®article SE1609: Medicare Policy Clarified for Prolonged Drug and Biological Infusions Started Incident to a Physician's Service Using an External Pump which is cited verbatim (in part) below:

“Medicare’s payment for the administration of the drug or biological billed to the MAC will also include payment for equipment used in furnishing the service. Equipment, such as an external infusion pump used to begin administration of the drug or biological that the patient takes home to complete the infusion, is not separately billable as durable medical equipment for a drug or biological paid under the section 1861(s)(2)(A) and (B) incident to benefit. The MAC may direct use of a code described by CPT or an otherwise applicableHCPCS code for the drug administration service. If necessary, the MAC may direct use of a miscellaneous code for the drug administration if there is no specified code that describes the drug administration service that also accounts for the cost of equipment that the patient takes home to complete the infusion that they later return to the physician or hospital.”

National Government Services has determined that the administration and pump charge should be reported under CPT code 96549 in addition to the HCPCS code for the chemotherapeutic agent provided. Under the incident to benefit, the physician must incur the cost of the drug. The allowance for CPT code 96549 will be considered all-inclusive for the chemotherapy administration and the pump. Therefore, no other administration, pump charge, set up or disconnect charges will be allowed. Providers should not report CPT code 96416, supplies, or pump code, (i.e., HCPCS code E0781).

Posted 5/5/2016

Biosimilar Modifier

The table below lists the current biosimilar HCPCS Codes, the product(s) that are associated with each code and the corresponding required modifier that is used to identify the product. The table will be updated quarterly when new permanent HCPCS codes and modifiers are available for biosimilar products that appear on the ASP price file.

Biosimilar HCPCS Code	Product Brand names	Corresponding Required Modifier
Q5101 Injection, Filgrastim (G-CSF), Biosimilar, 1 microgram	Zarxio	ZA- Novartis/Sandoz

          

HCPCS code for BLINCYTO® (blinatumomab) for injection for intravenous use. 

The Centers for Medicare & Medicaid Services (CMS) assigned a HCPCS code for BLINCYTO® which became effective on January 1, 2016.

HCPCS Code	BLINCYTO Long Descriptor	Effective Date
J9039	Injection, blinatumomab, 1mcg	1/1/2016

1/1/2016

Source: Centers for Medicare and Medicaid Services Alpha-Numeric HCPCS File

Source Link: CMS 2016 Alpha-Numeric HCPCS File

Permanent J-Code for Keytruda

The Center for Medicare and Medicaid Services (CMS) has assigned a permanent J-Code for KEYTRUDA. Effective January 1, 2016, the permanent J code for KEYTRUDA is J9271 Injection, Pembrolizumab, 1 mg. This means for dates of service on or after January 1, 2016 claims should be coded as “J9271 Injection, Pembrolizumab, 1 mg

New HCPCS Code for ramucirumab

The new code, J9308, is defined as Injection, ramucirumab, 5 mg. This code is effective January 1, 2016.  

Trade Name	HCPCS Code1	Strength	NDC*
CYRAMZA	J9308 Injection, ramucirumab, 5 mg	100 mg/10 mL (10 mg/mL) 500 mg/50 mL (10 mg/mL)	00002-7669-01 00002-7678-01

*NDC has been “zero-filled” to ensure creation of an 11-digit code that meets HIPAA standards. The zero-fill location is indicated in bold. HIPAA=Health Insurance Portability and Accountability Act.

Unique C Code for BLINCYTO

Effective April 1, 2015, BLINCYTO has been assigned a unique HCPCS C-code, C9449.

HCPCS Code	BLINCYTO Long Descriptor	Strength	Effective Date
C9449	Injection, blinatumomab, 1 mcg	35 mcg	4/1/2015

Source: April 2015 Update to the Hospital Outpatient Prospective Payment System (OPPS)

Source Link: http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Downloads/C-Codes-Effective-04-01-15.zip

Level II HCPCS C CODE FOR KEYTRUDA

Effective January 1, 2015, KEYTRUDA has been assigned a Level II HCPCS Code C9027 for Medicare hospital outpatient claims.

http://www.merckaccessprogram-keytruda.com/

http://www.merck.com/product/usa/pi_circulars/k/keytruda/keytruda_pi.pdf

PERMANENT J-CODE FOR  GAZYVA

Centers for Medicare & Medicaid Services (CMS) has granted a permanent J-code for GAZYVA® (obinutuzumab) that goes into effect January 1, 2015. The J-code for GAZYVA is J9301 (injection, obinutuzumab, 10 mg).

If you have any questions or concerns regarding billing and coding for GAZYVA, you can seek assistance from one of the dedicated Specialists at GAZYVA Access Solutions at (888) 249‐4918, or visit Genentech-Access.com/GAZYVA for more information.

 

UNIQUE C-CODE FOR GAZYVA
The Centers for Medicare & Medicaid Services (CMS) has granted a unique C-code for GAZYVA™ (obinutuzumab). The C-code for GAZYVA is C9021 (injection, obinutuzumab, 10 mg). The C-code goes into effect on April 1, 2014, and should be used until a permanent J-code is assigned. If granted, the permanent J-code is expected to be available for use starting January 1, 2015.

The C-code is used primarily in the Medicare hospital outpatient setting. However, some payers accept this C-code instead of the unclassified J- or C-codes when billing for GAZYVA. Please check with your payers to verify codes and special billing requirements. You can seek assistance from one of the dedicated Specialists at GAZYVA Access Solutions at (888) 249‐4918, or visit Genentech-Access.com/GAZYVA for more information.

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J-CODES NOW AVAILABLE FOR ANTI-HER2 MBC THERAPIES

The Centers for Medicare & Medicaid Services (CMS) have granted KADCYLA® (ado-trastuzumab emtansine) and PERJETA® (pertuzumab) permanent J-codes that go into effect January 1, 2014. The J-code for KADCYLA is J9354 (injection, ado-trastuzumab emtansine, 1 mg) and the J-code for PERJETA is J9306 (injection, pertuzumab, 1 mg). http://www.cgsmedicare.com/jc/pubs/news/2013/1213/cope24092.html

Please be sure to prepare your systems for the introduction of these 2 new codes.

For additional assistance, you can contact one of the dedicated Specialists at Genentech BioOncology™ Access Solutions at (888) 249‐4918, or visit http://www.genentech-access.com/biooncology/hcp for more information

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NEW HCPCS CODE FOR ZALTRAP

Effective January 1, 2014, a new HCPCS code for Zaltrap (ziv-aflibercept) has been assigned by CMS.

J9400 Injection, ziv-aflibercept, 1 mg

This new HCPCS code replaces the HCPCS code of J9999.

• For additional details relative to this change, please visit:
http://www.cgsmedicare.com/jc/pubs/news/2013/1213/cope24092.html

For full prescribing Information on Zaltrap, visit www.zaltrap.com

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NEW HCPCS code for Kyprolis 

Effective January 1, 2014, a new HCPCS code for Kyprolis® (carfilzomib) for Injection has been assigned by CMS.

The new code, J9047, is defined as “Injection, carfilzomib, 1mg”

• For additional details relative to this change, please visit:
http://www.cgsmedicare.com/jc/ pubs/news/2013/1213/ cope24092.html

View the KYPROLIS package insert at: http://kyprolis.com/.

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New CMS HCPCS code for Neupogen® (filgrastim)

On November 29, 2013, CMS released the Healthcare Common Procedure Coding System (HCPCS) code set updates that will be effective January 1, 2014. 

• Effective January 1, 2014, CMS has assigned a new HCPCS code for Neupogen®, J1442 injection, filgrastim 1 mcg.  This new HCPCS code replaces the old Neupogen® HCPCS codes of J1440 for 300 mcgs and J1441 for 480 mcgs.
• As a result of the new Neupogen® HCPCS code, providers will need to enter the Neupogen® units used in the billing process to distinguish which Neupogen® dose was used (e.g. 300 mcg single use vial/prefilled syringe or 480 mcg single use vial/prefilled syringe).
• For additional details relative to this change, here is the CMS website:  http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html

 

For the full Prescribing Information on Neupogen® (filgrastim), please go to:

http://www.neupogen.com

 

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