HCPCS replacement codes, effective July 1, 2023, established

C9151 replaces C9399, J3490, J3590 and J9999 when billing for Syfovre (pegcetacoplan) for facility only

The Centers for Medicare & Medicaid Services has established a permanent procedure code for the specialty medical drug Syfovre (pegcetacoplan).

All facility services through June 30, 2023, will continue to be reported with code C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with C9151.

All professional services will continue to be reported with C9399, J3490, J3590 and J9999.

Prior authorization is still required for all groups opted into the Medical Benefit Drug program.

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

J0457 replaces S0073 when billing for Aztreonam

CMS has established a permanent procedure code for the specialty medical drug Aztreonam.

All services through June 30, 2023, will continue to be reported with code S0073. All services performed on and after July 1, 2023, must be reported with J0457.

J0665 replaces S0020 when billing for Bupivicaine

CMS has established a permanent procedure code for the specialty medical drug Bupivicaine.

All services through June 30, 2023, will continue to be reported with code S0020.  All services performed on and after July 1, 2023, must be reported with J0665.                         

J0736 and J0737 replace S0077 when billing for clindamycin phosphate

CMS has established a permanent procedure code for the specialty medical drug clindamycin phosphate.

All services through June 30, 2023, will continue to be reported with code S0077. All services performed on and after July 1, 2023, must be reported with J0736 or J0737.

J1836 replaces S0030 when billing for Metronidazole

CMS has established a permanent procedure code for the specialty medical drug Metronidazole.

All services through June 30, 2023, will continue to be reported with code S0030. All services performed on and after July 1, 2023, must be reported with J1836.

J1440 replaces C9399, J3490, J3590 and J9999 when billing for fecal microbiota, live – jslm

CMS has established a permanent procedure code for the specialty medical drug fecal microbiota, live – jslm.

All services through June 30, 2023, will continue to be reported with code C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J1440.

Prior authorization is required through the Medical Benefit Drug program for J1440 for all groups unless they are opted out of the program.

For groups that have opted out of the prior authorization program, this code is covered for its FDA-approved indications.

J1961 replaces C9399, J3490, J3590 and J9999 when billing for lenacapavir

CMS has established a permanent procedure code for the specialty medical drug lenacapavir.

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J1961.

J2249 replaces C9399, J3490, J3590 and J9999 when billing for reminazolam

CMS has established a permanent procedure code for the specialty medical drug reminazolam.

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J2249.

J2329 replaces C9399, J3490, J3590, J9999 when billing for ublituximab-xiiy

CMS has established a permanent procedure code for the specialty medical drug ublituximab-xiiy.

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J2329.

J2371 replaces J2370 when billing for phenylephrine hydrochloride

CMS has established a permanent procedure code for the specialty medical drug phenylephrine hydrochloride.

All services through June 30, 2023, will continue to be reported with code J2370. All services performed on and after July 1, 2023, must be reported with J2371.

J2372 replaces J2370 when billing for phenylephrine hydrochloride (Biorphen)

CMS has established a permanent procedure code for the specialty medical drug phenylephrine hydrochloride (Biorphen).

All services through June 30, 2023, will continue to be reported with code J2370. All services performed on and after July 1, 2023, must be reported with J2372.

J2427 replaces C9399, J3490, J3590 and J9999 when billing for paliperidone palmitate extended release (invega hafyera or invega trinza)

CMS has established a permanent procedure code for the specialty medical drug paliperidone palmitate extended release (invega hafyera or invega trinza).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J2427.

J2561 replaces C9399, J3490, J3590 and J9999 when billing for phenobarbital sodium (Sezaby)

CMS has established a permanent procedure code for the specialty medical drug phenobarbital sodium (Sezaby).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J2561.

J7213 replaces C9399, J3490, J3590, J9999 and J7199 when billing for IXINITY

CMS has established a permanent procedure code for the specialty medical drug IXINITY.

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590, J9999 and J7199. All services performed on and after July 1, 2023, must be reported with J7213.

J9029 replaces C9399, J3490, J3590 and J9999 when billing Adstiladrin (nadofaragene firadenovec-vncg)

CMS has established a permanent procedure code for the specialty medical drug Adstiladrin (nadofaragene firadenovec-vncg), a gene/cellular therapy drug.

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J9029.

J9063 replaces C9399, J3490, J3590, J9999 and C9146 when billing for ELAHERE (mirvetuximab soravtansine-gynx)

CMS has established a permanent procedure code for the specialty medical drug ELAHERE (mirvetuximab soravtansine-gynx).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590, J9999 and C9146. All services performed on and after July 1, 2023, must be reported with J9063.

J9259 replaces C9399, J3490, J3590 and J9999 when billing for American Regent (paclitaxel protein-bound particles)

CMS has established a permanent procedure code for the specialty medical drug American Regent (paclitaxel protein-bound particles).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J9259.

Prior authorization through Carelon (formerly AIM) is required for all groups opted into the Carelon prior authorization program.

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

J9322 replaces C9399, J3490, J3590 and J9999 when billing for pemetrexed (Bluepoint)

CMS has established a permanent procedure code for the specialty medical drug pemetrexed (Bluepoint).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J9322.

Prior authorization through Carelon is required for all groups opted into the Carelon prior authorization program.

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

J9323 replaces C9399, J3490, J3590 and J9999 when billing for pemetrexed ditromethamine, 10 mg

CMS has established a permanent procedure code for the specialty medical drug pemetrexed ditromethamine, 10 mg.

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J9323.

Prior authorization through Carelon is required for all groups opted into the Carelon prior authorization program.

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

J9347 replaces C9399, J3490, J3590, J9999 and C9147 when billing for Imjudo (tremelimumab-actl)

CMS has established a permanent procedure code for the specialty medical drug Imjudo (tremelimumab-actl).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590, J9999 and C9147. All services performed on and after July 1, 2023, must be reported with J9347.

J9350 replaces C9399, J3490, J3590 and J9999 when billing for Lunsumio (mosunetuzumab-axgb)

CMS has established a permanent procedure code for the specialty medical drug Lunsumio (mosunetuzumab-axgb).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J9350.

J9380 replaces C9399, J3490, J3590, J9999 and C9148 when billing for Tecvayli (teclistamab-cqyv)

CMS has established a permanent procedure code for the specialty medical drug Tecvayli (teclistamab-cqyv).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590, J9999 and C9148. All services performed on and after July 1, 2023, must be reported with J9380.

J9381 replaces C9399, J3490, J3590, J9999 and C9149 when billing for Tzield (teplizumab-mzwv)

CMS has established a permanent procedure code for the specialty medical drug Tzield (teplizumab-mzwv). 

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590, J9999 and C9149. All services performed on and after July 1, 2023, must be reported with J9381.

Prior authorization is required through the Medical Benefit Drug program for J9381 for all groups unless they’re opted out of the program.

For groups that have opted out of the prior authorization program, this code is covered for its FDA-approved indications.

J1576 replaces C9399, J3490, J3590 and J9999 when billing for immune globulin (Panzyga)

CMS has established a permanent procedure code for the specialty medical drug immune globulin (Panzyga).

All services through June 30, 2023, will continue to be reported with code C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2023, must be reported with J1576.

Prior authorization is required through the Medical Benefit Drug program for J1576 for all groups unless they are opted out of the program.

For groups that have opted out of the prior authorization program, this code is covered for its FDA-approved indications.

J1920 replaces C9399, J3490, J3590, J9999 and C9147 when billing for labetalol hydrochloride

CMS has established a permanent procedure code for the specialty medical drug labetalol hydrochloride.
All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590, J9999 and C9147. All services performed on and after July 1, 2023, must be reported with J1920.

J1921 replaces C9399, J3490, J3590, J9999 and C9147 when billing for labetalol hydrochloride (Hikma)

CMS has established a permanent procedure code for the specialty medical drug labetalol hydrochloride (Hikma).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590, J9999 and C9147. All services performed on and after July 1, 2023, must be reported with J1921.

J1805 replaces C9399, J3490, J3590, J9999 and C9147 when billing for esmolol hydrochloride

CMS has established a permanent procedure code for the specialty medical drug esmolol hydrochloride.

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590, J9999 and C9147. All services performed on and after July 1, 2023, must be reported with J1805.

J1806 replaces C9399, J3490, J3590, J9999 and C9147 when billing for esmolol hydrochloride (WG Critical Care)

CMS has established a permanent procedure code for the specialty medical drug esmolol hydrochloride (WG Critical Care).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590, J9999 and C9147. All services performed on and after July 1, 2023, must be reported with J1806.

J1813 replaces C9399, J3490, J3590, J9999 and C9148 when billing for insulin (Lyumjev) for administration through DME (i.e., insulin pump)

CMS has established a permanent procedure code for the specialty medical drug insulin (Lyumjev) for administration through durable medical equipment (i.e., insulin pump).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590, J9999 and C9148. All services performed on and after July 1, 2023, must be reported with J1813.

J1814 replaces C9399, J3490, J3590, J9999 and C9148 when billing for insulin (Lyumjev)
CMS has established a permanent procedure code for the specialty medical drug insulin (Lyumjev).

All services through June 30, 2023, will continue to be reported with codes C9399, J3490, J3590, J9999 and C9148. All services performed on and after July 1, 2023, must be reported with J1814.

Carelon Medical Benefits Management (formerly AIM Specialty Health) is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services.