Heads up: this issue is from December 16, 2025. Because it covers time-sensitive coding and regulatory topics, some details may have changed since. See the latest issues for current guidance.
Sometimes when you work in reimbursement, you feel like a total loser. Today, I am feeling that way. As you all know, I do not distribute the new ASPs in this newsletter each quarter. My attorneys do not want me discussing drug margins EVER, and publishing pricing might infer that. A little paranoid--but it is what it is. Anyway, I went into the ASP files, now also known as the Payment Limit Files, and I was shocked (which many of you may not be) that some drugs are being paid at AMP, Average Manufacturers' Price. AMP is generally only used for Medicaid rebates. I suddenly remembered that CMS uses AMP when the Office of Inspector General (OIG aka the Oy General) informs CMS that a product’s ASP is at least 5% higher than its AMP; the ASP for the billing code has exceeded the AMP for the billing code by 5% or more in two consecutive quarters, or three of the previous four quarters immediately preceding the quarter to which the price substitution would be applied. I was just shocked to see that theory put into practice. If you want to find out more about Medicare Payment Limits for drugs, this handy dandy information sheet will tell you--then you can be smarter than I feel!
Here are the new HCPCS for dates of service on or after the first working day of the year:
New Codes
HCPCS LONG DESCRIPTION
J0013 Esketamine, nasal spray, 1 mg
J0162 Injection, epinephrine (fresenius), not therapeutically equivalent to j0165, 0.1 mg
J0654 Injection, liothyronine, 1 mcg
J1073 Testosterone pellet, implant, 75 mg
J1736 Injection, meloxicam (delova), 1 mg
J1737 Injection, meloxicam (azurity), 1 mg
J1837 Injection, posaconazole, 1 mg
J2516 Injection, pentamidine isethionate, 1 mg
J2596 Injection, vasopressin (long grove), not therapeutically equivalent to j2598, 1 unit
J2711 Injection, neostigmine methylsulfate 0.1 mg and glycopyrrolate 0.02 mg
J3291 Injection, tranexamic acid in sodium chloride, 5 mg
J3376 Injection, vancomycin hcl (hikma), not therapeutically equivalent to j3373, 10 mg
J3379 Injection, valproate sodium, 5 mg
J3387 Injection, elivaldogene autotemcel, per treatment
J3389 Topical administration, prademagene zamikeracel, per treatment
J7299 Intrauterine copper contraceptive (miudella)
J7528 Mycophenolate mofetil, for suspension, oral, 100 mg
J9184 Injection, gemcitabine hydrochloride (avyxa), 200 mg
J9256 Injection, nipocalimab-aahu, 3 mg
J9282 Mitomycin, intravesical instillation, 1 mg
J9326 Injection, telisotuzumab vedotin-tllv, 1 mg
Discontinued Codes (A ton!)
HCPC LONG DESCRIPTION
C9089 Bupivacaine, collagen-matrix implant, 1 mg
C9305 Injection, nipocalimab-aahu, 3 mg
C9306 Injection, telisotuzumab vedotin-tllv, 1 mg
J0172 Injection, aducanumab-avwa, 2 mg
J0190 Injection, biperiden lactate, per 5 mg
J0200 Injection, alatrofloxacin mesylate, 100 mg
J0205 Injection, alglucerase, per 10 units
J0215 Injection, alefacept, 0.5 mg
J0288 Injection, amphotericin b cholesteryl sulfate complex, 10 mg
J0350 Injection, anistreplase, per 30 units
J0365 Injection, aprotonin, 10,000 kiu
J0380 Injection, metaraminol bitartrate, per 10 mg
J0395 Injection, arbutamine hcl, 1 mg
J0710 Injection, cephapirin sodium, up to 1 gm
J0715 Injection, ceftizoxime sodium, per 500 mg
J0795 Injection, corticorelin ovine triflutate, 1 microgram
J0889 Daprodustat, oral, 1 mg, (for esrd on dialysis)
J1267 Injection, doripenem, 10 mg
J1330 Injection, ergonovine maleate, up to 0.2 mg
J1443 Injection, ferric pyrophosphate citrate solution (triferic), 0.1 mg of iron
J1444 Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron
J1445 Injection, ferric pyrophosphate citrate solution (triferic avnu), 0.1 mg of iron
J1452 Injection, fomivirsen sodium, intraocular, 1.65 mg
J1457 Injection, gallium nitrate, 1 mg
J1562 Injection, immune globulin (vivaglobin), 100 mg
J1572 Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized, 500 mg
J1620 Injection, gonadorelin hydrochloride, per 100 mcg
J1655 Injection, tinzaparin sodium, 1000 iu
J1710 Injection, hydrocortisone sodium phosphate, up to 50 mg
J1945 Injection, lepirudin, 50 mg
J2504 Injection, pegademase bovine, 25 iu
J2513 Injection, pentastarch, 10% solution, 100 ml
J2910 Injection, aurothioglucose, up to 50 mg
J2940 Injection, somatrem, 1 mg
J2995 Injection, streptokinase, per 250,000 iu
J3280 Injection, thiethylperazine maleate, up to 10 mg
J3305 Injection, trimetrexate glucuronate, per 25 mg
J3310 Injection, perphenazine, up to 5 mg
J3320 Injection, spectinomycin dihydrochloride, up to 2 gm
J3355 Injection, urofollitropin, 75 iu
J3364 Injection, urokinase, 5000 iu vial
J3365 Injection, iv, urokinase, 250,000 i.u. vial
J3400 Injection, triflupromazine hcl, up to 20 mg
J7309 Methyl aminolevulinate (mal) for topical administration, 16.8%, 1 gram
J7310 Ganciclovir, 4.5 mg, long-acting implant
J7505 Muromonab-cd3, parenteral, 5 mg
J7513 Daclizumab, parenteral, 25 mg
J8562 Fludarabine phosphate, oral, 10 mg
J8650 Nabilone, oral, 1 mg
J9019 Injection, asparaginase (erwinaze), 1,000 iu
J9020 Injection, asparaginase, not otherwise specified, 10,000 units
J9098 Injection, cytarabine liposome, 10 mg
J9151 Injection, daunorubicin citrate, liposomal formulation, 10 mg
J9165 Injection, diethylstilbestrol diphosphate, 250 mg
J9212 Injection, interferon alfacon-1, recombinant, 1 microgram
J9270 Injection, plicamycin, 2.5 mg
Q0174 Thiethylperazine maleate, 10 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Q2017 Injection, teniposide, 50 mg
Q5109 Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg
Q9969 Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose
S0013 Esketamine, nasal spray, 1 mg
S0080 Injection, pentamidine isethionate, 300 mg
S0189 Testosterone pellet, 75 mg
Long Descriptor Change
J7322 Hyaluronan or derivative, hymovis or hymovis one, for intra-articular injection, 1 mg
For more information, particularly if your group uses skin substitutes, it is right here.
Have questions about HCPCS billing? Ask us!!!
