New HCPCS Level II Codes for July

New HCPCS Level II Codes for July

And one new code with an effective date retroactive to April 1.

The results of the Centers for Medicare & Medicaid Services’ (CMS’) first quarter 2023 drug and biological HCPCS Level II code application review cycle is now available. CMS accepted 36 applications for new drugs and biologicals and approved 23. The new codes established during this review cycle will be included in the July 2023 quarterly update and will be effective July 1, 2023, with the exception of one code.

CMS has also published a list of HCPCS Level II codes for products approved by the Food and Drug Administration (FDA) under the 505(b)(2) new drug application (NDA) or biologics license application (BLA) process and products not otherwise classified (NEC).

Late Entry for April 2023 Update

CMS has established a new code for a blood clotting factor product, effective April 1, 2023, “due to the unique programmatic needs within the hospital outpatient settings.” HEMGENIX®, approved by the FDA in November 2022, is “the first and only one-time gene therapy for adults with hemophilia B,” according to the applicant, CSL Behring, LLC. This one-time use drug is indicated for the treatment of adults with hemophilia B who currently use Factor IX prophylaxis therapy or have current or historical life-threatening hemorrhage, or have repeated, serious spontaneous bleeding episodes.

J1411 Injection, etranacogene dezaparvovec-drlb, per therapeutic dose

New Codes for July 2023 Update

The rest of the new codes established during the first quarter 2023 drug and biological review cycle will go into effect July 1, 2023.

J9347 Injection, tremelimumab-actl, 1 mg

J2329 Injection, ublituximab-xiiy, 1 mg

J9029 Injection, nadofaragene firadenovec-vncg, per therapeutic dose

Q5131 Injection, adalimumab-aacf (idacio), biosimilar, 20 mg J9063, “Injection, mirvetuximab soravtansine-gynx, 1 mg

J9350 Injection, mosunetuzumab-axgb, 1 mg

J1440 Fecal microbiota, live -jslm, 1 ml

J9380 Injection, teclistamab-cqyv, 0.5 mg

               Discontinue C9148, “Injection, teclistamab-cqyv, 0.5 mg

J9381 Injection, teplizumab-mzwv, 5 mcg

               Discontinue C9149, “Injection, teplizumab-mzwv, 5 mcg

J9058 Injection, bendamustine hydrochloride (apotex), 1 mg

J9259 Injection, paclitaxel protein-bound particles (american regent) not therapeutically equivalent to j9264 1 mg

J2249 Injection, remimazolam, 1 mg

J9059 Injection, bendamustine hydrochloride (baxter), 1 mg

J9056 Injection, bendamustine hydrochloride (vivimusta), 1 mg

J2561 Injection, phenobarbital sodium (sezaby), 1 mg

J1961 Injection, lenacapavir, 1 mg

J9323 Injection, pemetrexed (hospira) not therapeutically equivalent to j9305, 10 mg

J2806 Injection, sincalide (maia) not therapeutically equivalent to j2805, 5 micrograms

Q4278 Epieffect, per square centimeter

Q4276 Orion, per square centimeter

Q4277 Woundplus membrane or e-graft, per square centimeter

Q4280 Xcell amnio matrix, per square centimeter

Q4282 Cygnus dual, per square centimeter

Q4281 Barrera sl or barrera dl, per square centimeter

Q4272 Esano a, per square centimeter

Q4273 Esano aaa, per square centimeter

Q4274 Esano ac, per square centimeter

Q4275 Esano aca, per square centimeter

Q4283 Biovance tri-layer or biovance 3l, per square centimeter

Q4284 Dermabind sl, per square centimeter

Drugs with multiple routes of administration should be billed with either modifier JA for intravenous infusion of the drug or modifier JB for subcutaneous injection of the drug, according to CMS. Coverage inquiries should be directed to the payer.

CMS is also establishing 27 new HCPCS Level II codes to separately identify products approved under the 505(b)(2) NDA or the BLA process. For the list of codes, see Appendix A in the April 27 announcement.

In the official quarterly update to the HCPCS Level II code set, effective July 1, 2023, there are 63 codes added and 14 codes discontinued, including G2024 Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source. The long code descriptor for J2426 is changed to Injection, paliperidone palmitate extended release (invega sustenna), 1 mg, and there is a payment change for K1034 Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count.

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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