HCPCS replacement codes established

The HCPCS procedure codes listed below are effective Jan. 1, 2019:

J0185 replaces J3490 and C9463 when billing for Cinvanti^®The Centers for Medicare & Medicaid Services has established a permanent procedure code for Cinvanti.

All services through Dec. 31, 2018, will continue to be reported with J3490 or C9463.
All services performed on and after Jan. 1, 2019, must be reported with J0185.

J0517 replaces J3490, J3590 and C9466 when billing for Fasenra^®
CMS has established a permanent procedure code for Fasenra.

All services through Dec. 31, 2018, will continue to be reported with J3490, J3590 or C9466. All services performed on and after Jan. 1, 2019, must be reported with J0517.

Prior authorization is still required for Fasenra (benralizumab) when reported with the new procedure code J0517 for all groups unless they are opted out of the prior authorization program.

J0567 replaces J3490 and J3590 when billing for Brineura^®
CMS has established a permanent procedure code for Brineura.

All services through Dec. 31, 2018, will continue to be reported with J3490 or J3590. All services performed on and after Jan. 1, 2019, must be reported with J0567.

Prior authorization is still required for Brineura (cerliponase alfa) when reported with the new procedure code J0567 for all groups unless they are opted out of the prior authorization program.

All groups have the option to opt out of the prior authorization program. If prior authorization isn’t a requirement for a group, a manual review is required for procedure code J0567 for those groups.

J0584 replaces J3490 and J3590 when billing for Crysvita^®
CMS has established a permanent procedure code for Crysvita.

All services through Dec. 31, 2018, will continue to be reported with J3490 or J3590. All services performed on and after Jan. 1, 2019, must be reported with J0584.

Prior authorization is still required for Crysvita (burosumab-twza) when reported with the new procedure code J0584 for all groups unless they are opted out of the prior authorization program.

J1095 replaces J3490 when billing for Dexycu^®
CMS has established a permanent procedure code for Dexycu.

All services through Dec. 31, 2018, will continue to be reported with J3490. All services performed on and after Jan. 1, 2019, must be reported with J1095.

J1301 replaces J3490 and J3590 when billing Radicava^®
CMS has established a permanent procedure code for Radicava.

All services through Dec. 31, 2018, will continue to be reported with J3490 or J3590. All services performed on and after Jan. 1, 2019, must be reported with J1301.

Prior authorization is still required for Radicava (edaravone) when reported with the new procedure code J1301 for all groups unless they are opted out of the prior authorization program.

All groups have the option to opt out of the prior authorization program. If prior authorization isn’t a requirement for a group, a manual review is required for procedure code J1301 for those groups.

J1454 replaces J3490 when billing for Akynzeo^®
CMS has established a permanent procedure code for Akynzeo.

All services through Dec. 31, 2018, will continue to be reported with J3490. All services performed on and after Jan. 1, 2019, must be reported with J1454.

J1746 replaces J3490 and J3590 when billing for Trogarzo^®
CMS has established a permanent procedure code for Trogarzo.

All services through Dec. 31, 2018, will continue to be reported with J3490 or J3590. All services performed on and after Jan. 1, 2019, must be reported with J1746.

Prior authorization is still required for Trogarzo (ibalizumab-ulyk) when reported with the new procedure code J1746 for all groups unless they are opted out of the prior authorization program.

J2186 replaces J3490 when billing for Vabomere^®
CMS has established a permanent procedure code for Vabomere.

All services through Dec. 31, 2018, will continue to be reported with J3490. All services performed on and after Jan. 1, 2019 must be reported with J2186.

J2797 replaces J3490 when billing for VARUBI IV^®
CMS has established a permanent procedure code for VARUBI IV.

All services through Dec. 31, 2018, will continue to be reported with J3490. All services performed on and after Jan. 1, 2019, must be reported with J2797.

J3245 replaces J3490 and J3590 when billing for Ilumya^®
CMS has established a permanent procedure code for Ilumya.

All services through Dec. 31, 2018, will continue to be reported with J3490 or J3590. All services performed on and after Jan. 1, 2019, must be reported with J3245.

Prior authorization is still required for Ilumya (tildrakizumab-asmn) when reported with the new procedure code J3245 for all groups unless they are opted out of the prior authorization program.

J3304 replaces Q9993 when billing for Zilretta^®
CMS has established a permanent procedure code for Zilretta.

All services through Dec. 31, 2018, will continue to be reported with Q9993. All services performed on and after Jan. 1, 2019, must be reported with J3304.

Prior authorization is still required for Zilretta (triamcinolone acetonide preservative-free, extended-release microsphere formulation) when reported with the new procedure code J3304 for all groups unless they are opted out of the prior authorization program.

J3397 replaces J3490 and J3590 when billing for Mepsevii^®
CMS has established a permanent procedure code for Mepsevii.

All services through Dec. 31, 2018, will continue to be reported with J3490 or J3590. All services performed on and after Jan. 1, 2019, must be reported with J3397.

Prior authorization is still required for Mepsevii (vestronidase alfa-vjbk) when reported with the new procedure code J3397 for all groups unless they are opted out of the prior authorization program.

All groups have the option to opt out of the prior authorization program. If prior authorization isn’t a requirement for a group, a manual review is required for procedure code J3397 for those groups.

J3398 replaces J3490, J3590 and C9032 when billing for Luxturna^®
CMS has established a permanent procedure code for Luxturna.

All services through Dec. 31, 2018, will continue to be reported with J3490, J3590 or C9032. All services performed on and after Jan. 1, 2019, must be reported with J3398.

Prior authorization is still required for Luxturna (voretigene neparvovec-rzyl) when reported with the new procedure code J3398 for all groups unless they are opted out of the prior authorization program.

J7170 replaces Q9995 when billing for Hemlibra^®
CMS has established a permanent procedure code for Hemlibra.

All services through Dec. 31, 2018, will continue to be reported with Q9995. All services performed on and after Jan. 1, 2019, must be reported with J7170.

J7203 replaces J7199 when billing for Rebinyn^®
CMS has established a permanent procedure code for Rebinyn (coagulation Factor IX [recombinant], GlycoPEGylated).

All services through Dec. 31, 2018, will continue to be reported with J7199. All services performed on and after Jan. 1, 2019, must be reported with J7203.

J9057 replaces J9999 and C9030 when billing for Aliqopa^®
CMS has established a permanent procedure code for Aliqopa.

All services through Dec. 31, 2018, will continue to be reported with J9999 or C9030. All services performed on and after Jan. 1, 2019, must be reported with J9057.

J9173 replaces J9999 when billing for Imfinzi^®
CMS has established a permanent procedure code for Imfinzi.

All services through Dec. 31, 2018, will continue to be reported with J9999. All services performed on and after Jan. 1, 2019, must be reported with J9173.

J9229 replaces J9999 and C9028 when billing for Besponsa^®
CMS has established a permanent procedure code for Besponsa.

All services through Dec. 31, 2018, will continue to be reported with J9999 or C9028. All services performed on and after Jan. 1, 2019, must be reported with J9229.

J9311 replaces J3590 and C9467 when billing for Rituxan Hycela^®
CMS has established a permanent procedure code for Rituxan Hycela.

All services through Dec. 31, 2018, will continue to be reported with J3590 or C9467. All services performed on and after Jan. 1, 2019, must be reported with J9311.

For more information about HCPCS codes, see the article titled “2019 HCPCS Update: Coverage decisions on 2019 procedure codes now available.”

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.