HCPCS replacement codes, effective Jan. 1, 2022, established

J0172 replaces J3490, J3590, J9999 and C9399  when billing for Aduhelm (aducanumab-avwa)

The Centers for Medicare & Medicaid Services has established a permanent procedure code for Aduhelm™.

All services through Dec. 31, 2021, will continue to be reported with codes J3490, J3590, J9999 or C9399.

All services performed on and after Jan. 1, 2022, must be reported with J0172.

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

For groups that have opted out of the Medical Benefit Drug Prior Authorization program, this service isn’t a covered benefit.

J2506 replaces J3490 and J3590 when billing for Neulasta

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

All services through Dec. 31, 2021, will continue to be reported with codes J3490 and J3590. All services performed on and after Jan. 1, 2022, must be reported with J2506.

Prior authorization through AIM Specialty Health® is required for all groups 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.

J9021 replaces J9999 and C9399 when billing for Rylaze (asparaginase, recombinant)

CMS has established a permanent procedure code for Rylaze.

All services through Dec. 31, 2021, will continue to be reported with code J9999 or C9399. All services performed on and after Jan. 1, 2022, must be reported with J9021.

J9061 replaces J9999 and C9083 when billing for Rybrevant (amivantamab-vmjw)

CMS has established a permanent procedure code for Rybrevant™.

All services through Dec. 31, 2021, will continue to be reported with codes J9999 and C9083. All services performed on and after January 1, 2022, must be reported with J9061. 

Prior authorization through AIM is required for all groups 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.

J9272 replaces J3490, J3590 and C9082 when billing for Jemperli (dostarlimab-gxly)

CMS has established a permanent procedure code for Jemperli.

All services through Dec. 31, 2021, will continue to be reported with codes J3490, J3590 and C9082. All services performed on and after Jan. 1, 2022, must be reported with J9272.

Prior authorization through AIM is required for all groups opted in to the AIM Prior Authorization Program.

For groups that aren’t in the AIM Prior Authorization Program, this code requires manual review.

Q2055 replaces J3490, J3590 and C9081 when billing for Abecma (Idecabtagene vicleucel)

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

All services through Dec. 31, 2021, will continue to be reported with codes J3490, J3590 and C9081. All services performed on and after Jan. 1, 2022, must be reported with Q2055.

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

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