Heads up: this issue is from July 2, 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 July 7, 2025 (accounts for the holiday), the drug changes documented in Change Request Transmittal 13258, Change Request 14091, are listed below.
Just a note--many COVID vaccines and antibodies have been removed from OPPS.
New HCPCS Codes Gaining Pass-Through Status
- C9174 Injection, datopotamab deruxtecan-dlnk, 1 mg
- C9175 Injection, treosulfan, 50 mg
- J9174 Injection, docetaxel (beizray), 1 mg
- J9220 Injection, indigotindisulfonate sodium, 1 mg
- J9289 Injection, nivolumab, 2 mg and hyaluronidase-nvhy
- J9382 Injection, zenocutuzumab-zbco, 1 mg
- Q5100 Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg
Existing HCPCS Codes Gaining Pass-Through Status
- J9038 Injection, axatilimab-csfr, 0.1 mg
- J9249 Injection, melphalan (apotex), 1 mg
- Q5152 Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg
HCPCS Codes Losing Pass-Through Status
- A9596 Gallium ga-68 gozetotide, diagnostic, (illuccix),
- 1 millicurie
- J1302 Injection, sutimlimab-jome, 10 mg
- J1306 Injection, inclisiran, 1 mg
- J2356 Injection, tezepelumab-ekko, 1 mg
- J2777 Injection, faricimab-svoa, 0.1 mg
- J9274 Injection, tebentafusp-tebn, 1 microgram
- J9332 Injection, efgartigimod alfa-fcab, 2mg
- Q2056 Obecabtagene autoleucel, 10 up to 400 million CD19 car-positive viable t cells, including leukopheresis and dose preparation procedures
- Q5125 Injection, filgrastim-ayow, biosimilar, (releuko),1 microgram
Deleted HCPCS Codes
- J0171 Injection, adrenalin, epinephrine, 0.1 mg
- J0173 Injection, epinephrine (belcher), not therapeutically
- equivalent to j0171, 0.1 mg
- J2310 Injection, naloxone hydrochloride, per 1 mg
- J2311 Injection, naloxone hydrochloride (zimhi), 1 mg
- J3370 Injection,C9173 Injection, filgrastim-txid (nypozi), biosimilar, 1
- microgram E1 N/A
- Q5148 Injection, filgrasti vancomycin hcl, 500 mg
- J3371 Injection, vancomycin hcl (mylan), not therapeutically equivalent to j3370, 500 mg
- J3372 Injection, vancomycin hcl (xellia), not therapeutically equivalent to j3370, 500 mg
- J9340 Injection, thiotepa, 15 mg
Code Status Change as of July 7, 2025 (Went from E2 to K)
- Q5136 Injection, denosumab-bbdz (jubbonti/wyost),
- biosimilar, 1 mg
- Q9998 Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg
Code Status Change Retroactive to April 1, 2025
- J9038 Injection, axatilimab-csfr, 0.1 mg
- Q5151 Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg
- Q5152 Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg
- C9173 Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram
- Q5148 Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram
Code Descriptor Substantial Changes as of July 1, 2025
- J1954 Injection, leuprolide acetate for depot suspension (cipla), 7.5 mg CHANGES TO Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg
- J9292 Injection, pemetrexed (avyxa), not therapeutically equivalent to j9305, 10 mg CHANGES TO Injection, pemetrexed dipotassium, 10 mg
- Q9998 Injection, ustekinumab-aekn (selarsdi), 1 mg CHANGES TO Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg
That's all for this quarter.--but review the transmittal for non-drug changes. For more information, check the transmittal.
