Heads up: this issue is from March 27, 2025. Because it covers time-sensitive coding and regulatory topics, some details may have changed since. See the latest issues for current guidance.
As you know, the Hospital Outpatient Fee Schedule changes for a subset of drugs each quarter. For drugs given on or after April Fools Day, 2025, the drug changes documented in Transmittal 13135, Change Request 13993 are listed below.
New HCPCS Codes Gaining Pass-Through Status
- A9611 Flurpiridaz f 18, diagnostic, 1 millicurie
- C9301 Obecabtagene autoleucel, up to 400 million cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
- C9302 Injection, zanidatamab-hrii, 2 mg
- C9303 Injection, zolbetuximab-clzb, 1mg
- C9304 Injection, marstacimab-hncq, subcutaneous, 0.5 mg
- J9054 Injection, bortezomib (boruzu), 0.1 mg
- Q2057 Afamitresgene autoleucel, including leukapheresis and dose preparation procedures, per therapeutic dose
- Q5147 Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg
Existing HCPCS Codes Gaining Pass-Through Status
- J0138 Injection, acetaminophen 10 mg and ibuprofen 3mg
- J3300 Injection, triamcinolone acetonide, preservative-free, 1 mg
- J9072 Injection, cyclophosphamide (avyxa), 5 mg
- J9292 Injection, pemetrexed (avyxa), not therapeutically equivalent to j9305, 10 mg
HCPCS Codes Losing Pass-Through Status
- C9088 Instillation, bupivacaine and meloxicam, 1mg/0.03 mg
- J0248 Injection, remdesivir,
- J2779 Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg
- J2998 Injection, plasminogen, human-tvmh, 1 mg
- J3299 Injection, triamcinolone acetonide (xipere), 1 mg
- J9273 Injection, tisotumab vedotin-tftv, 1 mg
- J9304 Injection, pemetrexed (PEMFEXY), 10 mg
- J9331 Injection, sirolimus protein-bound particles, 1 mg
Deleted HCPCS Codes
- J1094 Injection, dexamethasone acetate, 1 mg
- J1300 Injection, eculizumab, 10 mg
- J1810 Injection, droperidol and fentanyl citrate, up to 2 ml ampule
- J1890 Injection, cephalothin sodium, up to 1 gram
- J1940 Injection, furosemide, up to 20 mg
- J9037 Injection, belantamab mafodotin-blmf, 0.5 mg
- J9247 Injection, melphalan flufenamide, 1mg
- Q5139 Injection, eculizumab-aeeb (bkemv), biosimilar, 10 mg
- S0017 Injection, aminocaproic acid, 5 grams
- S0028 Injection, famotidine, 20 mg
- S0032 Injection, nafcillin sodium, 2 grams
- S0039 Injection, sulfamethoxazole and trimethoprim, 10 ml
Code Status Change as of April 1, 2025
- C9173 Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram from G to E1
Code Descriptor Changes as of April 1, 2025
- J9073 Injection, cyclophosphamide (ingenus), 5 mg to Injection, cyclophosphamide (dr.reddy's), 5 mg
That's all for this quarter. For more information, check the transmittal.
