HCPCS replacement codes established

J0223 replaces J3490, J3590 and C9056 when billing for Givlaari (givosiran)

The Centers for Medicare & Medicaid Services has established a permanent procedure code for Givlaari^®.

All services through June 30, 2020, will continue to be reported with code J3490, J3590 or C9056. All services performed on and after July 1, 2020, must be reported with J0223.

Prior authorization is required for all groups unless they are opted out of the prior authorization program.

For groups that have opted out of the prior authorization program, this code requires manual review for individual consideration.

J0691 replaces J3490 when billing for Xenleta (lefamulin)

CMS has established a permanent procedure code for Xenleta™.

All services through June 30, 2020, will continue to be reported with code J3490. All services performed on and after July 1, 2020, must be reported with J0691.

Prior authorization is required for all groups unless they are opted out of the prior authorization program.

For groups that have opted out of the prior authorization program, this code requires manual review for individual consideration.

J0791 replaces J3490, J3590 and C9053 when billing for Adakveo (crizanlizumab-tmca)

CMS has established a permanent procedure code for Adakveo^®.

All services through June 30, 2020, will continue to be reported with code J3490, J3590 or C9053. All services performed on and after July 1, 2020, must be reported with J0791.

Prior authorization is required for all groups unless they are opted out of the prior authorization program.

J0896 replaces J3490 and J3590 when billing for Reblozyl (luspatercept-aamt)

CMS has established a permanent procedure code for Reblozyl^®.

All services through June 30, 2020, will continue to be reported with code J3490 or J3590. All services performed on and after July 1, 2020, must be reported with J0896.

Prior authorization is required for all groups unless they are opted out of the prior authorization program.

For groups that have opted out of the prior authorization program, this code requires manual review for individual consideration.

J1429 replaces J3490 and J3590 when billing for Vyondys 53 (golodirsen)

CMS has established a permanent procedure code for Vyondys 53.

All services through June 30, 2020, will continue to be reported with code J3490 or J3590. All services performed on and after July 1, 2020, must be reported with J1429.

Prior authorization is required for all groups unless they are opted out of the prior authorization program.

For groups that have opted out of the prior authorization program, this code requires manual review for individual consideration.

J1558 replaces J1599 when billing for Xembify (immune globulin subcutaneous, human-klhw)

CMS has established a permanent procedure code for Xembify^®.

All services through June 30, 2020, will continue to be reported with code J1599. All services performed on and after July 1, 2020, must be reported with J1558.

Prior authorization is required for all groups unless they are opted out of the prior authorization program.

J3399 replaces J3490, J3590 and C9399 when billing for Zolgensma (onasemnogene abeparvovec-xioi) 

CMS has established a permanent procedure code for Zolgensma^®.

All services through June 30, 2020, will continue to be reported with code J3490, J3590 or C9399. All services performed on and after July 1, 2020, must be reported with J3399.

Prior authorization is required for all groups unless they are opted out of the prior authorization program.

For groups that have opted out of the prior authorization program, this code requires manual review for individual consideration.

Q5121 replaces J3490 and J3590 when billing for Avsola (infliximab-axxq)

CMS has established a permanent procedure code for Avsola™.

All services through June 30, 2020, will continue to be reported with code J3490 or J3590. All services performed on and after July 1, 2020, must be reported with Q5121.

Prior authorization is required for all groups unless they are opted out of the prior authorization program.

For groups that have opted out of the prior authorization program, this code requires manual review for individual consideration.

J0742 replaces J3490 and J3590 when billing for Recarbrio (imipenem, cilastatin and relebactam)

CMS has established a permanent procedure code for Recarbrio™.

All services through June 30, 2020, will continue to be reported with code J3490 or J3590. All services performed on and after July 1, 2020, must be reported with J0742.

J1201 replaces J3490, J3590 and C9057 when billing for Quzyttir (cetirizine hydrochloride injection)

CMS has established a permanent procedure code for Quzyttir^®.

All services through June 30, 2020, will continue to be reported with code J3490, J3590 or C9057. All services performed on and after July 1, 2020, must be reported with J1201.

J7169 replaces J3490 and C9041 when billing for Andexxa

CMS has established a permanent procedure code for Andexxa^®.

All services through June 30, 2020, will continue to be reported with code J3490 or C9041. All services performed on and after July 1, 2020, must be reported with J7169.

J7204 replaces J3490 when billing for Esperoct

CMS has established a permanent procedure code for Esperoct^®.

All services through June 30, 2020, will continue to be reported with code J3490. All services performed on and after July 1, 2020, must be reported with J7204.

J9177 replaces J3490 and J3590 when billing for Padcev

CMS has established a permanent procedure code for Padcev™.

All services through June 30, 2020, will continue to be reported with code J3490 or J3590. All services performed on and after July 1, 2020, must be reported with J9177.

J9358 replaces J3490 and J3590 when billing for ENHERTU (fam-trastuzumab deruxtecan-nxki)

CMS has established a permanent procedure code for ENHERTU^®.

All services through June 30, 2020, will continue to be reported with code J3490 or J3590. All services performed on and after July 1, 2020, must be reported with J9358.

Q5119 replaces J3590 when billing for Ruxience (rituximab-pvvr)

CMS has established a temporary procedure code for Ruxience^®.

All services through June 30, 2020, will continue to be reported with code J3590. All services performed on and after July 1, 2020, must be reported with Q5119.

Q5120 replaces J3490, J3590 and C9058 when billing for Ziextenzo (pegfilgrastim-bmez)

CMS has established a temporary procedure code for Ziextenzo^®.

All services through June 30, 2020, will continue to be reported with code J3490, J3590 or C9058. All services performed on and after July 1, 2020, must be reported with Q5120.