CMS Approves 10 New Drug Codes

CMS Approves 10 New Drug Codes

Ten new HCPCS Level II codes for drugs and biologicals will be payable for Medicare, effective for claims with dates of service on or after July 1, 2019.

HCPCS Level II is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT code set jurisdiction, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician’s office.

The Centers for Medicare & Medicaid Services updates the HCPCS Level II code set quarterly.

Code Descriptor TOS
J1444 Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron 1, L
J7208 Injection, factor viii, (antihemophilic factor, recombinant), pegylatedaucl, (jivi), 1 i.u. 1
J7677 Revefenacin inhalation solution, fda-approved final product, noncompounded, administered through DME, 1 microgram 1, P
J9030 BCG live intravesical instillation, 1 mg 1, P
J9036 Injection, bendamustine hydrochloride, (Belrapzo/bendamustine), 1 mg 1
J9356 Injection, trastuzumab, 10 mg and Hyaluronidase-oysk 1, P
Q5112 Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg 1, P
Q5113 Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg 1, P
Q5114 Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg 1, P
Q5115* Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg 1, P

* MLN Matters MM11296 Revised, issued June 12, updated the descriptor for Q5115.

J1444 is separate and distinct from J1443 Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron, according to Rockwell Medical. The biopharmaceutical company says, “Triferic is the only FDA-approved therapy indicated to replace iron and maintain hemoglobin in hemodialysis patients via dialysate during each dialysis treatment.”

Append modifier JE Administered via dialysate as appropriate.

Be aware that Horizon Blue Cross Blue Shield of New Jersey announced that, beginning for services provided on or after Aug. 15, 2019, Magellan Rx Management will conduct medical necessity and appropriateness reviews for hemophilia drugs. Other insurance plans may follow suit.

Deleted and Revised Codes

Also note that Medicare will not pay for chemotherapy drug J9031 Bcg (intravesical) per instillation, effective for claims with dates of service on or after July 1, 2019, and the long and short descriptors for J9355 (brand name Herceptin) will be modified, effective for claims with dates of service on or after July 1, 2019. The TOS and all other indicators will remain the same:

J9355

Short Descriptor: Inj trastuzumab excl biosimi

Long Descriptor: Injection, trastuzumab, excludes biosimilar, 10 mg

J9355 requires a National Data Code.

What about drug waste?

To be certain you receive full reimbursement for drugs administered at your facility, you must submit Medicare claims for wasted drugs or biologicals from single-use vials using modifier JW Drug amount discarded/not administered to any patient.

CPB : Online Medical Billing Course


Source: MLN Matters MM11296

Renee Dustman
Follow me

Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman
Follow me

About Has 684 Posts

Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

Leave a Reply

Your email address will not be published. Required fields are marked *