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Wiki Medicare deleted HCPCS J1050

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tbelles

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So we have a patient that comes in or Depo injections to manage her menopausal symptoms.
It looks like Medicare deleted this code (J1050) in 2023. I spoke to someone at Medicare and she said to submit the claim with the description of medication and units and optional NDC in Box 19
and all should be well. So I did, and am getting denied again. Is there a replacement code for this? Is anyone else having this problem and if so, how are you getting paid?
 
I haven't heard anything about that, nor can I find anything to back this up. Do you have a link to any information? Also Depo has never been covered by Medicare (A/B), although it may be paid by some advantage plans (C) or the drug plan. (D)
 
tbelles said:
So we have a patient that comes in or Depo injections to manage her menopausal symptoms.
It looks like Medicare deleted this code (J1050) in 2023. I spoke to someone at Medicare and she said to submit the claim with the description of medication and units and optional NDC in Box 19
and all should be well. So I did, and am getting denied again. Is there a replacement code for this? Is anyone else having this problem and if so, how are you getting paid?
Click to expand...

J1050 is still a valid HCPC.

If you look at the July 2023 quarterly HCPC update, it is still listed as valid: https://www.cms.gov/medicare/coding/hcpcsreleasecodesets/hcpcs-quarterly-update

It's excluded from the Medicare Physician Fee Schedule, but that's not new. I don't think it has ever been on the MPFS.
 
I am so confused about the denial then. It's telling me invalid code and prior to 2023, this same patient was paid every single time with no problems?
 
cbosi1 said:
Hi. Did you ever find a resolution to this? We have a 27-year-old Medicare on Depo also.
Click to expand...
Per the HCPCS database for January 2025, J1050 is still an active valid code. The dose was changed from 150 mg to 1 mg in 2013 so why Medicare would not pay is a mystery. In addition the data base shows that this code can be billed as an in office service or by a DME supplier. You would bill a quantity for J1050 as 150 if 150 mg was injected.
 
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