Heads up: this issue is from January 22, 2025. Because it covers time-sensitive coding and regulatory topics, some details may have changed since. See the latest issues for current guidance.
While many of us were probably super busy during the holidays, CMS apparently was too since they did not release the OPPS (Medicare Outpatient Prospective Payment System) changes for Q1 until early January. The Transmittal 13032, Change Request 13933 was issued January 10 and the following are the portions related to drugs, effectively January 1, 2025
- New HCPCS Codes getting Pass-Through Status 1/1/2025:
- C9173, Injection, filgrastim-txid (nypozi,), 1 mic
- J0870, Imelstat, 1 mg
- Existing HCPCS gaining Pass-Through Status as of 1/1/2025
- A9697, Injection, carboxydextran-coated superparamagnetic iron oxide, per study dose
- J0175, Injection, donanemab-azbt, 2 mg
- J2468, Injection, palonosetron hydrochloride (posfrea), 25 micrograms
- J2601, Injection, vasopressin (baxter), 1 unit
- J9329, Injection, tislelizumab-jsgr, 1 mg,
- HCPCS Codes for drugs losing Pass-Through status after 12/31/2024
- A9595, Piflufolastat f-18, diagnostic, 1 millicurie
- J0219, Injection, avalglucosidase alfa-ngpt, 4 mg
- J0491, Injection, anifrolumab-fnia, 1 mg
- J9021, Injection, asparaginase, recombinant, (rylaze), 0.1 mg
- J9071, Injection, cyclophosphamide, (auromedics), 5 mg
- HCPCS Codes deleted as of 1/1/2025
- 90654, Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use
- 90630, Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
- J0135, injection, adalimumab, 20 mg
- J0570 Buprenorphine implant, 74.2 mg
- J2796, Injection,romiplostim, 10 micrograms
- J2806, Injection, sincalide (maia), not therapeutically equivalent to j2805, 5 micrograms
- J9058, Injection, bendamustine hydrochloride (apotex), 1 mg
- J9059, Injection, bendamustine hydrochloride (baxter), 1 mg
- J9259, Injection, paclitaxel protein-bound particles (american regent), not therapeutically equivalent to j9264, 1 mg
- Q0516 Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 30-days
- Q0517 Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 60-days
- Q0518 Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 90-days
- Q0519 Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 30-days
- Q0520 Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 60-days
- Q5131 Injection, adalimumab-aacf (idacio), biosimilar, 20 mg
- Q5132 Injection, adalimumab-afzb (abrilada), biosimilar, 10 mg
- HCPCS Code changing Payment Status Indicator to E1 as of January 1, 2025
- J9198 Injection, gemcitabine hydrochloride, (infugem), 100 mg
- HCPCS Codes Changing Payment Status Retroactive to October 1, 2024
- J9059. Injection, bendamustine hydrochloride (baxter), 1 mg (K Status)
- J9072 Injection, cyclophosphamide (dr. reddy's), 5 mg (E2 Status)
- J9329 Injection, tislelizumab-jsgr, 1mg (K Status)
- Q5131.Injection, adalimumab-aacf (idacio), biosimilar, 20 mg (K Status)
- HCPCS Codes with New Long Descriptors as of January 1, 2025. The new ones are
- 90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
- J2468. Injection, palonosetron hydrochloride (posfrea), 25 micrograms
- J9033 Injection, bendamustine hydrochloride, 1 mg
- J9072. Injection, cyclophosphamide (avyxa), 5 mg
- Previously Bundled Radiopharmaceuticals paid separately as January 1, 2025
- A9515 Choline C 11, diagnostic, per study dose
- A9521 technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries
- A9542 indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicurie
- A9547. indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie
- A9548. indium in-111 pentetate, diagnostic, per 0.5 millicurie
- A9557. technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries
- A9568. technetium tc-99m arcitumomab, diagnostic, per study dose, up to 25 millicuries
For more information about ALL OPPS Changes for January 1, 2025, see the Transmittal.
