We saw the new HCPCS codes for dates of services on or after January 1, and we had to say: "What the what..??". There are drugs, some of which were approved a while ago, that appear to be generic; however, they are deemed "not therapeutically equivalent" per new regulations pertinent to an arcane FDA status called 505(b)(2). To read more about this (which qualifies you as a total nerd). Click here.
Here are the new codes for dates of service starting 1/1/2023:
HCPC LONG DESCRIPTION
JZ Zero drug amount discarded/not administered to any patient
LU Fractionated payment of car-t therapy
C9144 Injection, bupivacaine (posimir), 1 mg
E2103 Non-adjunctive, non-implanted continuous glucose monitor or receiver
J0134 Injection, acetaminophen (fresenius kabi) not therapeutically equivalent to j0131, 10 mg
J0136 Injection, acetaminophen (b braun) not therapeutically equivalent to j0131, 10 mg
J0173 Injection, epinephrine (belcher) not therapeutically equivalent to j0171, 0.1 mg
J0225 Injection, vutrisiran, 1 mg
J0283 Injection, amiodarone hydrochloride (nexterone), 30 mg
J0611 Injection, calcium gluconate (wg critical care), per 10 ml
J0689 Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg
J0701 Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg
J0703 Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg
J0877 Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg
J0891 Injection, argatroban (accord), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
J0892 Injection, argatroban (accord), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
J0893 Injection, decitabine (sun pharma) not therapeutically equivalent to j0894, 1 mg
J0898 Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)
J0899 Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)
J1456 Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg
J1574 Injection, ganciclovir sodium (exela) not therapeutically equivalent to j1570, 500 mg
J1611 Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg
J1643 Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units
J1954 Injection, leuprolide acetate for depot suspension (lutrate), 7.5 mg
J2021 Injection, linezolid (hospira) not therapeutically equivalent to j2020, 200 mg
J2184 Injection, meropenem (b. braun) not therapeutically equivalent to j2185, 100 mg
J2247 Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg
J2251 Injection, midazolam hydrochloride (wg critical care) not therapeutically equivalent to j2250, per 1 mg
J2272 Injection, morphine sulfate (fresenius kabi) not therapeutically equivalent to j2270, up to 10 mg
J2281 Injection, moxifloxacin (fresenius kabi) not therapeutically equivalent to j2280, 100 mg
J2311 Injection, naloxone hydrochloride (zimhi), 1 mg
J2327 Injection, risankizumab-rzaa, intravenous, 1 mg
J2401 Injection, chloroprocaine hydrochloride, per 1 mg
J2402 Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg
J3244 Injection, tigecycline (accord) not therapeutically equivalent to j3243, 1 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
J9046 Injection, bortezomib, (dr. reddy's), not therapeutically equivalent to j9041, 0.1 mg
J9048 Injection, bortezomib (fresenius kabi), not therapeutically equivalent to j9041, 0.1 mg
J9049 Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg
J9314 Injection, pemetrexed (teva) not therapeutically equivalent to J9305, 10 mg
J9393 Injection, fulvestrant (teva) not therapeutically equivalent to j9395, 25 mg
J9394 Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg
Here are modifiers and codes with a descriptor change effective 1/1/2023:
- JG Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes
- TB Drug or biological acquired with 340b drug pricing program discount, reported for i informational purposes for select entities
- J0131 Injection, acetaminophen, not otherwise specified,10 mg
- J0610 Injection, calcium gluconate (fresenius kabi), per 10 ml
- J9041 Injection, bortezomib, 0.1 mg
Here are the discontinued codes for 1/1/2023:
- J2400 Injection, chloroprocaine hydrochloride, per 30 ml
- J9044 Injection, bortezomib, not otherwise specified, 0.1 mg
Transmittal 11737 outlines changes to the Hospital Prospective Payment System for Q1 2023. This transmittal is jam-packed with information updating the outpatient system for 2023. If you are a hospital biller or coder, please read this 58-page document. It is key to your being ready for 2023.
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Drugs receiving the coveted pass-through status starting January 1 include the following:
- J0225 Injection, vutrisiran, 1 mg
- J2327 Injection, risankizumab-rzaa, intravenous, 1 mg
- Q5126 Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg
- J1932 Injection, lanreotide, (cipla), 1 mg
- Q5124 Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg
- Drugs losing pass-through status include the following:
- C9046 Cocaine hydrochloride nasal solution (goprelto), 1 mg
- C9047 Injection, caplacizumab-yhdp, 1 mg
- J0121 Injection, omadacycline, 1 mg
- J0222 Injection, Patisiran, 0.1 mg
- J0291 Injection, plazomicin, 5 mg
- J0642 Injection, levoleucovorin (khapzory), 0.5 mg
- J0691 Injection, lefamulin, 1 mg
- J1095 Injection, dexamethasone 9 percent, intraocular, 1 microgram
- J1096 Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
- J1303 Injection, ravulizumab-cwvz, 10 mg
- J1632 Injection, brexanolone, 1mg
- J1943 Injection, aripiprazole lauroxil, (aristada initio), 1 mg
- J2798 Injection, risperidone, (perseris), 0.5 mg
- J3031 Injection, fremanezumab-vfrm, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered)
- J3111 Injection, romosozumab-aqqg, 1 mg
- J3245 Injection, tildrakizumab, 1 mg
- J7169 Injection, coagulation factor Xa (recombinant), inactivated (andexxa), 10mg
- J7208 Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl (jivi) 1 i.u.
- J9036 Injection, bendamustine hydrochloride (belrapzo/bendamustine), 1 mg
- J9119 Injection, cemiplimab-rwlc, 1 mg
- J9204 Injection, mogamulizumab-kpkc, 1 mg
- J9210 Injection, emapalumab-lzsg, 1 mg
- J9269 Injection, tagraxofusp-erzs, 10 micrograms
- J9309 Injection, polatuzumab vedotin-piiq, 1 mg
- J9313 Injection, moxetumomab pasudotox-tdfk, 0.01 mg
- J9356 Injection, trastuzumab, 10 mg and hyaluronidase-oysk
- Q5107 Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg
- Q5108 Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg
- Q5110 Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram
- Q5111 Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg
- Q5117 Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg
- Please be aware that many of the "new " separate, 505(b)(2) J-codes have a bundled status under the fee schedule as their pass-through period has expired.
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Beginning January 1, 2023, HCPCS code C9399 (Unclassified drugs or biologicals) will be added to the comprehensive APC (C-APC) exclusions list. Please see the updated CMS internet-only manual language in the Medicare Claims Processing Manual, Pub.100-04, Chapter 4, section 10.2.3 – Comprehensive APCs for a list of all CAPC exclusions, including the new exclusion of any drug or biological described by HCPCS code C9399.
If you are in a hospital or owned by one, you should definitely check out this transmittal for a comprehensive look at OPPS changes starting on January 1. If you want to check out the HCPCS update, it is here.
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