HCPCS replacement codes established

J1823 replaces J3490 and J3590 when billing for Uplizna (inebilizumab‑cdon)

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug Uplizna^® (inebilizumab‑cdon).

All services through Dec. 31, 2020, will continue to be reported with codes J3490 and  J3590. All services performed on and after Jan. 1, 2021, must be reported with J1823.

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 is covered for the FDA‑approved indications.
 
Site of care prior authorization is required through the Medical Benefit Drug Program.

J7352 replaces J3490 and J3590 when billing for Scenesse (afamelanotide injectable implant)

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug Scenesse (afamelanotide injectable implant).

All services through Dec. 31, 2020, will continue to be reported with codes J3490 and J3590. All services performed on and after Jan. 1, 2021, must be reported with J7352.

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 is covered for the FDA‑approved indications.

J9144 replaces J3490, J3590 and C9062 when billing for Darzalex FasPro (daratumumab and hyaluronidase-fihj)

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug Darzalex FasPro™ (daratumumab and hyaluronidase‑fihj).

All services through Dec, 31, 2020, will continue to be reported with codes J3490 and J3590. Facilities can continue to report C9062 through Dec. 31, 2020. All services performed on and after Jan. 1, 2021, must be reported with J9144.

J9223 replaces J3490 and when billing for Zepzelca (lurbinectedin)

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug Zepzelca (lurbinectedin).

All services through Dec. 31, 2020, will continue to be reported with code J3490. All services performed on and after Jan. 1, 2021, must be reported with J9223.

J9281 replaces J9999 and C9064 when billing for Jelmyto (mitomycin)

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug Jelmyto™ (mitomycin).

All services through Dec. 31, 2020, will continue to be reported with code J9999 and facilities can continue to report C9064 through Dec. 31, 2020. All services performed on and after Jan. 1, 2021, must be reported with J9281.

J9316 replaces J3590 when billing for Phesgo (pertuzumab, trastuzumab and hyaluronidase‑zzxf)

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug Phesgo (pertuzumab, trastuzumab and hyaluronidase‑zzxf).

All services through Dec. 31, 2020, will continue to be reported with code J3590. All services performed on and after Jan. 1, 2021 must be reported with J9316.

J9317 replaces J3590 and C9066 for Trodelvy (sacituzumab govitecan‑hziy)

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug Trodelvy™ (sacituzumab govitecan‑hziy).

All services through Dec. 31, 2020, will continue to be reported with code J3590. Facilities can continue to report C9066 through Dec. 31, 2020. All services performed on and after Jan. 1, 2021, must be reported with J9317.

S0013 replaces J3490 and J3590 when billing for Spravato (esketamine)

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug Spravato^® (esketamine).

All services through Dec. 31, 2020, will continue to be reported with codes J3490 and J3590. All services performed on and after Jan. 1, 2021, must be reported with S0013.

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 is covered for the FDA‑approved indications.