HCPCS replacement codes established

The HCPCS procedure codes listed below are effective Jan. 1, 2018.

J0565 replaces J3490 and J3590 when billing for Zinplava^®
The Centers for Medicare & Medicaid Services has established a permanent procedure code for Zinplava^®.

All services through Dec. 31, 2017, will continue to be reported with code J3490 or J3590. All services performed on and after Jan. 1, 2018, must be reported with J0565.

J1428 replaces J3490 and J3590 when billing for Exondys51^®
CMS has established a permanent procedure code for Exondys51^®.

All services through Dec. 31, 2017, will continue to be reported with code J3490 or J3590. All services performed on and after Jan. 1, 2018, must be reported with J1428.

Prior authorization is still required for Exondys51 (eteplirsen) when reported with the new procedure code J1428.

J1555 replaces J1599, J3490 and J3590 when billing for Cuvitru^®
CMS has established a permanent procedure code for Cuvitru^®.

All services through Dec. 31, 2017, will continue to be reported with code J1599, J3490 or J3590. All services performed on and after Jan. 1, 2018, must be reported with J1555.

Prior authorization is still required for Cuvitru (immune globulin) when reported with the new procedure code J1555.

J1627 replaces J3490 when billing for Sustol^®
CMS has established a permanent procedure code for Sustol^®.

All services through Dec. 31, 2017, will continue to be reported with code J3490. All services performed on and after Jan. 1, 2018, must be reported with J1627.

Sustol continues to be covered for the Federal Drug Administration-approved indications as establisted on Aug. 9, 2016. Sustol (granisetron) is an extended-release injection, a serotonin-3 (5-HT3) receptor antagonist indicated in combination with other antiemetic’s in adults for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic chemotherapy or anthracycline and cyclophosphamide combination chemotherapy regimens.

J1726 replaces Q9986 when billing for Makena^®
CMS has established a permanent procedure code for Makena^®.

All services through Dec. 31, 2017, will continue to be reported with code Q9986. All services performed on and after Jan. 1, 2018, must be reported with J1726.
Prior authorization is still required for Makena (hydroxyprogesterone caproate) when reported with the new procedure code J1726.

J1729 replaces Q9985 when billing for hydroxyprogesterone caproate
CMS has established a permanent procedure code for hydroxyprogesterone caproate.

All services through Dec. 31, 2017, will continue to be reported with code Q9985. All services performed on and after Jan. 1, 2018, must be reported with J1729.

Prior authorization is still required for the specialty medical Injection, hydroxyprogesterone caproate, not otherwise specified when reported with the new procedure code J1729.

J2326 replaces J3490 and J3590 when billing for Spinraza^®
CMS has established a permanent procedure code for Spinraza^®.

All services through Dec. 31, 2017, will continue to be reported with code J3490 or J3590. All services performed on and after Jan. 1, 2018, must be reported with J2326.

Prior authorization is still required for Spinraza (nusinersen) when reported with the new procedure code J2326.

J2350 replaces J3490 and J3590 when billing for Ocrevus^®
CMS has established a permanent procedure code for Ocrevus^®.

All services through Dec. 31, 2017, will continue to be reported with code J3490 or J3590. All services performed on and after Jan. 1, 2018, must be reported with J2350.

Prior authorization is still required for Ocrevus (ocrelizumab) when reported with the new procedure code J2350.

J3358 replaces Q9989 when billing for Stelara^®
CMS has established a permanent procedure code for Stelara^®.

All services through Dec. 31, 2017, will continue to be reported with code Q9989. All services performed on and after Jan. 1, 2018, must be reported with J3358.

Prior authorization is still required for Stelara (ustekinumab) when reported with the new procedure code J3358.

J7210 replaces J7199 when billing for Afstyla^®
CMS has established a permanent procedure code for Afstyla^®.

All services through Dec. 31, 2017, will continue to be reported with code J7199. All services performed on and after Jan. 1, 2018, must be reported with J7210.

Afstyla continues to be covered for the FDA-approved indication of hemophilia.
Pharmacy doesn’t require preauthorization of this drug.

For more information about HCPCS codes, see the article titled “HCPCS Update: Coverage decisions on 2018 procedure codes now available,” also in this issue.