Here are HCPCS code changes that took effect Jan. 1

Procedure Code

Description

Procedure codes J0571, J0572, J0573, J0574 or J0575 replaced J3490 when billing for Subutex^® (buprenorphine) and Suboxone® (buprenorphine/naloxone)

All services from Aug. 1, 2008, through Dec. 31, 2014, will continue to be reported with code J3490. Services on and after Jan. 1, 2015, must be reported with the appropriate procedure code.

Subutex^® (buprenorphine) and Suboxone^® (buprenorphine/naloxone) are used for maintenance or detoxification treatment to help patients overcome the physical dependence of opioids (heroin/prescription painkillers). Both of these drugs are used in the initial stages of therapy to help in reducing the physical cravings for these substances while the patient is being treated for addiction.

Subutex is given during the first few days of treatment while Suboxone (buprenorphine hydrochloride and naloxone hydrochloride) is used in the maintenance state.

Procedure code J1439 replaces Q9970 when billing for Injectafer^® (Ferric Carboxymaltose) 1mg

All services from July 1, 2014, through Dec. 31, 2014, will continue to be reported with code Q9970. Services on and after Jan. 1, 2015, must be reported with procedure code J1439.

This procedure is approved for the treatment of iron deficiency anemia in adult patients.

Dosage and administration

• Up to 750 mg can be delivered in a single dose
• Give two doses separated by at least seven days for a total cumulative dose of 1500 mg per course.
• Administer intravenously by:
• Infusion of at least 15 minutes
• Slow push injection at the rate of approximately 100 mg (2 mL) per minute over at least 7.5 minutes

Note: For patients weighing less than 50 kg (110 lb), give each dose as 15 mg/kg body weight.  When administered via infusion, dilute up to 750 mg of iron in no more than 250 mL of sterile 0.9% sodium chloride injection, USP, such that the concentration of the infusion is not <2 mg of iron per mL and administer over at least 15 minutes. When administering as a slow intravenous push, give at the rate of approximately 100 mg (2 mL) per minute.

Procedure code J7181 replaces J7199 when billing for Tretten™

All services from Dec. 23, 2013, through Dec. 31, 2014, will continue to be reported with code J7199. Services on and after Jan. 1, 2015, must be reported with procedure code J7181.

Tretten™ is established as safe and effective for its FDA approved indication: to prevent bleeding in adults and children with congenital factor XIII A subunit deficiency.

Tretten is for intravenous use only.

 Dose:

• 35 international units per kilogram body weight once monthly to achieve a target trough level of FXIII activity at or above 10% using a validated assay.
• Consider dose adjustment if adequate coverage is not achieved with a 35 IU/kg dose.
• Once reconstituted, Tretten may be diluted with 0.9% sodium chloride to facilitate measurement of small volumes.

Inclusionary Guidelines:

Tretten (coagulation Factor XIII A-Subunit (recombinant)) indicated for:

• Routine prophylaxis of bleeding in people with congenital FXIII A-subunit deficiency.

Exclusionary Guidelines:

• Tretten is not approved for use in patients with congenital FXIII B-subunit deficiency.

Procedure code J7200 replaces J7199 when billing for RIXUBIS

All services from June 28, 2013, through Dec. 31, 2014, will continue to be reported with code J7199. Services on and after Jan. 1, 2015, must be reported with procedure code J7200.

RIXUBIS, coagulation factor IX (recombinant), is covered for routine prophylactic treatment, control of bleeding episodes and perioperative management in people who are 16 years of age and older with hemophilia B.

Procedure code J7201 replaces J7199 when billing for ALPROLIX^®

All services from March 28, 2014, through Dec. 31, 2014, will continue to be reported with code J7199. Services on and after Jan. 1, 2015, must be reported with procedure code J7201.

The FDA-approved ALPROLIX^®, coagulation factor IX (recumbinant), Fc fusion protein, is covered for approved indications in the control and prevention of bleeding episodes, perioperative (surgical) management and routine prophylaxis in adults and children with hemophilia B.

Inclusionary Guidelines:
ALPROLIX, coagulation factor IX (recombinant, Fc fusion protein, is a recombinant DNA-derived, coagulation factor IX concentrate indicated in adults and children with hemophilia B for:

• Control and prevention of bleeding episodes
• Perioperative management
• Routine prophylaxis to prevent or reduce the frequency of bleeding episodes

For the control and prevention of bleeding episodes, the management of bleeding during surgical procedures and for routine prophylaxis in adults and children with hemophilia B.

Exclusionary Guidelines:

ALPROLIX is not indicated for induction of immune tolerance in patients with hemophilia B.

Procedure code J7327 replaces J3490 when billing for MONOVISC™

Description:
Hyaluronan or derivative, monovisc, for intra-articular injection, per dose

All services from Feb. 25, 2014, through Dec. 31, 2014 will continue to be reported with code J3490. Services on and after Jan. 1, 2015, must be reported with procedure code J7327.

Monovisc™ has been established as safe and effective for its FDA-approved indication:  Monovisc is indicated for the treatment of pain in osteoarthritis of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy or simple analgesics (e.g., acetaminophen).
 
Monovisc is injected intra-articularly (directly into affected knee joints) to help restore lubrication and cushioning. Unlike most other products of its type, however, Monovisc is given in one injection, rather than a series of three or four weekly injections.

It is supplied in a 5.0 mL syringe containing 4.0 mL of Monovisc The contents of the syringe are sterile, non-pyrogenic and non-inflammatory.

If billed as an injection this is approved for Ford salary, GM/Delphi salary and Chrysler non-bargaining unit segments.

When billed as POIT, this is approved for all auto (hourly and salaried segments) and URMBT. Exclude Ford BPP; coverage is not allowed for infusion therapy in the office setting.

When reported as OPIV therapy in the outpatient department of a hospital, this is approved for all auto (hourly and salaried segments) and URMBT.

Procedure code A9606 replaces A9699 when billing for Xofigo^® (radium Ra 223 dichloride)

All services from May 15, 2013, through Dec. 31, 2014, will continue to be reported with A9699. Services on or after Jan. 1, 2015, must be reported with the appropriate procedure code.

Xofigo is indicated for the treatment of patients with castration-resistant prostate cancer, symptomatic bone metastases and no known visceral metastatic disease.

The recommended dose and schedule for Xofigo is 50 kBq/kg (1.35 microcuries/kg) administered by slow intravenous injection over one minute every four weeks for six doses.

Procedure code G0277 replaces C-1300 when billing for hyperbaric oxygen full-body chamber

All services from Oct. 1, 2013, through Dec. 31, 2014, will continue to be reported with C1300. Services on or after Jan. 1, 2015, must be reported with the appropriate procedure code.

CMS established four new modifiers – XE, XP, XS and XU, effective Jan.1, 2015

CMS established four new Healthcare Common Procedure Coding System modifiers defined as subsets of the 59 modifier.

Effective Jan. 1, 2015, Blue Cross Blue Shield of Michigan will accept the new modifiers: XE, XP, XS and XU. We are expecting CMS to publish additional guidance on selective editing of these new modifiers, along with any restrictions for reporting modifier 59. At that time, we’ll publish an update regarding BCBSM editing of these modifiers.

Until modifier 59 is given additional restrictions for its use, we’ll continue to edit -59 as it does today; along with modifiers XE, XP, XS and XU.