HCPCS replacement codes, effective July 1, 2022, established

J0739 replaces C9399 J3490, J3590 and J9999 when billing Apretude (ciltacabtagene autoleucel)

Effective July 1, 2022, the Centers for Medicare and Medicaid Services has established a permanent procedure code for specialty medical drug Apretude (cabotegravir extended-release injectable suspension).

Services can continue to be reported with J3490, J3590, C9399 and J9999 through June 30, 2022. All services performed on and after July 1, 2022, must be reported with J0739.

J1306 replaces C9399 J3490, J3590 and J9999 when billing Leqvio (inclisiran)

Effective July 1, 2022, CMS has established a permanent procedure code for specialty medical drug Leqvio (inclisiran).

Services can continue to be reported with C9399, J3490, J3590 and J9999 through June 30, 2022. All services performed on and after July 1, 2022, must be reported with J1306.

Prior authorization is still required for all groups unless they are opted out of the Specialty Medical Drug Prior Authorization program.

For groups that have opted out of the Medical Benefit Drug Program, this code is covered for its FDA-approved indications.

J1551 replaces J1599, C9399, J3490, J3590 and J9999 when billing Cutaquig (immune globulin subcutaneous [human]-hipp)

Effective July 1, 2022, CMS has established a permanent procedure code for specialty medical drug Cutaquig (immune globulin subcutaneous [human]-hipp).

All services through June 30, 2022, will continue to be reported with code J1599, C9399, J3490, J3590 and J9999.  All services performed on and after July 1, 2022, must be reported with J1551.

Prior authorization is required through the Medical Benefit Drug Program for J1551 for all groups unless they are opted out of the program.

Site-of-care prior authorization is required through the Medical Benefit Drug Program for J1551 for all groups unless they are opted out of the program.

For groups that have opted out of the Medical Benefit Drug Program, this code is covered for its FDA-approved indications.

J2356 replaces C9399, J3490, J3590 and J9999 when billing Tezspire (tezepelumab-ekko)

Effective July 1, 2022, CMS has established a permanent procedure code for specialty medical drug Tezspire (tezepelumab-ekko).

All services through June 30, 2022, will continue to be reported with code C9399, J3490, J3590 and J9999.  All services performed on and after July 1, 2022, must be reported with J2356.

Prior authorization is required through the Medical Benefit Drug Program for J2356 for all groups unless they are opted out of the program.

For groups that have opted out of the Medical Benefit Drug Program, this code is covered for its FDA-approved indications.

J2779 replaces C9093, C9399, J3490, J3590, J9999 when billing Susvimo (ranibizumab injection)

Effective July 1, 2022, CMS has established a permanent procedure code for specialty medical drug Susvimo (ranibizumab injection).

All services through June 30, 2022, will continue to be reported with code C9093, C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2022, must be reported with J2779.

Prior authorization is required through the Medical Benefit Drug Program for J2779 for all groups unless they are opted out of the program.

For groups that have opted out of the Medical Benefit Drug Program, this code is covered for its FDA-approved indications.

J2998 replaces C9090, C9399, J3490, J3590 and J9999 when billing Ryplazim (plasminogen, human-tvmh)

Effective July 1, 2022, CMS has established a permanent procedure code for specialty medical drug Ryplazim (plasminogen, human-tvmh).

All services through June 30, 2022, will continue to be reported with code C9090, C9399, J3490 J3590 and J9999. All services performed on and after July 1, 2022, must be reported with J2998.

Prior authorization is required through the Medical Benefit Drug Program for J2998 for all groups unless they are opted out of the rogram.

For groups that have opted out of the Medical Benefit Drug Program, this code is covered for its FDA-approved indications.

J3299 replaces C9092, C9399, J3490, J3590 and J9999 when billing Xipere (triamcinolone acetonide injectable suspension)

Effective July 1, 2022, CMS has established a permanent procedure code for specialty medical drug Xipere (triamcinolone acetonide injectable suspension).

All services through June 30, 2022, will continue to be reported with code C9092, C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2022, must be reported with J3299.

J9331 replaces C9091, C9399, J3490, J3590 and J9999 when billing Fyarro (sirolimus protein-bound particles for injectable suspension) (albumin-bound)

Effective July 1, 2022, CMS has established a permanent procedure code for specialty medical drug Fyarro (sirolimus protein-bound particles for injectable suspension) (albumin-bound).

All services through June 30, 2022, will continue to be reported with code C9091, C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2022, must be reported with J9331.

J9332 replaces C9399, J3490, J3590 and J9999 when billing Vyvgart (efgartigimod alfa-fcab)

Effective July 1, 2022, CMS has established a permanent procedure code for specialty medical drug Vyvgart (efgartigimod alfa-fcab).

All services through June 30, 2022, will continue to be reported with code C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2022, must be reported with J9332.

Prior authorization is required through the Medical Benefit Drug Program for J9332 for all groups unless they are opted out of the program.

For groups that have opted out of the Medical Benefit Drug Program, this service requires manual review.

Site-of-care prior authorization is required through the Medical Benefit Drug Program for J9332 for all groups unless they are opted out of the program.