HCPCS replacement codes, effective April 1, 2022, established

J0219 replaces C9085, C9399, J3490, J3590 and J9999 when billing for Nexviazyme (avalglucosidase alfa-ngpt)

The Centers for Medicare and Medicaid Services has established a permanent procedure code for specialty medical drug Nexviazyme (avalglucosidase alfa-ngpt).

All services through March 31, 2022, will continue to be reported with code C9085, C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2022, must be reported with J0219.

Prior authorization is still required for all groups opted in to the Medical Drug Prior Authorization and Site of Care program.

For groups that aren’t in the Medical Drug Prior Authorization and Site of Care program this code requires manual review.

J0491 replaces C9086, C9399, J3490, J3590 and J9999 when billing for Saphnelo (anifrolumab-fnia)

CMS has established a permanent procedure code for specialty medical drug Saphnelo (anifrolumab-fnia).

All services through March 31, 2022, will continue to be reported with code C9086, C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2022, must be reported with J0491.
Prior authorization is still required for all groups opted in to the Medical Drug Prior Authorization and Site of Care program.

For groups that aren’t in the Medical Drug Prior Authorization and Site of Care program this code is covered for the FDA-approved indications.

J9359 replaces C9084, C9399, J3490, J3590 and J9999 when billing for Zynlonta (loncastuximab tesirine-lpyl)

CMS has established a permanent procedure code for specialty medical drugZynlonta (loncastuximab tesirine-lpyl).

All services through March 31, 2022, will continue to be reported with code C9084, C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2022, must be reported with J9359.

AIM prior authorization is still 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.

J0879 replaces C9399, J3490, J3590 and J9999 when billing for Korsuva (difelikefalin)

CMS has established a permanent procedure code for Korsuva (difelikefalin).

All services through March 31, 2022, will continue to be reported with code C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2022, must be reported with J0879.

Korsuva is covered for the following FDA-approved indication: Treatment of moderate-to-severe pruritus associated with chronic kidney disease (CKD-aP) in adults undergoing hemodialysis.

J9273 replaces C9399, J3490, J3590 and J9999 when billing for Tivdak (tisotumab vedotin-tftv)

CMS has established a permanent procedure code for Tivdak (tisotumab vedotin-tftv).

All services through March 31, 2022, will continue to be reported with code C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2022, must be reported with J9273.

Tivdak is covered for the following FDA-approved indication: Treatment of adult patients with recurrent or metastatic cervical cancer with disease progression on or after chemotherapy.