HCPCS replacement codes established

J9348 replaces C9399, J3490, J3590 and J9999 when billing for Danyelza (naxitamab‑gqgk)

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug Danyelza^® (naxitamab‑gqgk).

All services through June 30, 2021, will continue to be reported with code C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2021, must be reported with J9348.

AIM Specialty Health^® prior authorization is required for all groups that opted in to the AIM prior authorization program.

For groups that aren’t in the AIM prior authorization program, this code is covered for the Food and Drug Administration‑approved indications.

J9353 replaces C9399, J3490, J3590 and J9999 when billing for Margenza (margetuximab‑cmkb)

CMS has established a permanent procedure code for specialty medical drug Margenza™ (margetuximab‑cmkb).

All services through June 30, 2021, will continue to be reported with code C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2021, must be reported with J9353.

AIM prior authorization is required for all groups that opted in to the AIM prior authorization program.

For groups that aren’t in the AIM prior authorization program, this code is covered for the FDA‑approved indications.

Q5123 replaces J3490 and J3590 when billing for Riabni (rituximab‑arrx)

CMS has established a permanent procedure code for specialty medical drug Riabni™ (rituximab‑arrx).
All services through June 30, 2021, will continue to be reported with code J3490 and  J3590. All services performed on and after July 1, 2021, must be reported with Q5123.

AIM prior authorization is required for all groups that opted in to the AIM prior authorization program.

For groups that aren’t in the AIM prior authorization program, this code is covered for the FDA‑approved indications.

J0224 replaces J3490, J3590 and C9074 when billing for Oxlumo (lumasiran)

CMS has established a permanent procedure code for Oxlumo™ (lumasiran).

All services through June 30, 2021, will continue to be reported with code J3490, J3590 or C9074. All services performed on and after July 1, 2021, must be reported with J0224.

Prior authorization is required for all groups unless they are opted out of the Medical Benefit Drug Program.

J7168 replaces J3490, J3590 and C9132 when billing for Kcentra (prothrombin complex concentrate, human)

CMS has established a permanent procedure code for Kcentra^® (prothrombin complex concentrate, human).

All services through June 30, 2021, will continue to be reported with code J3490, J3590 or C9132. All services performed on and after July 1, 2021, must be reported with J7168.

Kcentra is covered for the following FDA-approved indication: For the urgent reversal of acquired coagulation factor deficiency induced by vitamin K antagonist (VKA, e.g., warfarin) therapy in adult patients with acute major bleeding or the need for an urgent surgery/invasive procedure.

J1951 replaces J3490 and J3590 when billing for Fensolvi (leuprolide acetate)

CMS has established a permanent procedure code for Fensolvi^® (leuprolide acetate).

All services through June 30, 2021, will continue to be reported with code J3490 or J3590. All services performed on and after July 1, 2021, must be reported with J1951.

Fensolvi is covered for the following FDA‑approved indication: For the treatment of pediatric patients age 2 years and older with central precocious puberty.