HCPCS replacement codes established, effective Oct. 1

J0801 replaces J0800 when billing for Acthar Gel (corticotropin)

Effective Oct. 1, 2023, the Centers for Medicare & Medicaid Services has established a new procedure code for specialty medical drug Acthar Gel (corticotropin).                     

All services through Sept. 30, 2023, should be reported with code J0800. All services performed on and after Oct. 1, 2023, must be reported with J0801.

Prior authorization is required through the Medical Benefit Drug Program for J0801 for all groups unless they have opted out of the program.

For groups that have opted out of the prior authorization program, this service requires manual review for individual consideration.

J0802 replaces C9399, J3490, J3590 and J9999 when billing for Purified Cortrophin Gel (corticotropin)

Effective Oct. 1, 2023, CMS has established a permanent procedure code for specialty medical drug Purified Cortrophin Gel (corticotropin).

All services through Sept. 30, 2023, should be reported with code C9399, J3490, J3590 and J9999. All services performed on and after Oct. 1, 2023, must be reported with J0802.

Prior authorization is required through the Medical Benefit Drug Program for J0802 for all groups unless they have opted out of the program

For groups that have opted out of the prior authorization program, this service requires manual review for individual consideration.

J2781 replaces C9399, J3490, J3590 and J9999 when billing for Syfovre (pegcetacoplan)

Effective Oct. 1, 2023, CMS has established a permanent procedure code for specialty medical drug Syfovre (pegcetacoplan).

All services through Sept. 30, 2023, should be reported with code C9399, J3490, J3590 and J9999. All services performed on and after Oct. 1, 2023, must be reported with J2781.

Prior authorization is required through the Medical Benefit Drug Program for J2781 for all groups unless they have opted out of the program.

For groups that have opted out of the prior authorization program, this service requires manual review for individual consideration.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.