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.
|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:
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.
Source: MLN Matters MM11296