HCPCS replacement codes established, effective July 1

J9361 replaces C9399, J3490, J3590, J9999 when billing for efbemalenograstim alfa-vuxw

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug efbemalenograstim alfa-vuxw.

All services through June 30, 2024, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2024, must be reported with J9361.         

Prior authorization is required through the Medical Benefit Drug Program for J9361 for all groups unless they are opted out of the program.

Q5137 replaces C9399, J3490, J3590, J9999 when billing for ustekinumab-auub (Wezlana), biosimilar, subcutaneous

CMS has established a permanent procedure code for specialty medical drug ustekinumab-auub (Wezlana™), biosimilar, subcutaneous, 1 mg.

All services through June 30, 2024, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2024, must be reported with Q5137.        

Prior authorization is required through the Medical Benefit Drug Program for Q5137 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 U.S. Food and Drug Administration-approved indications.

Q5138 replaces C9399, J3490, J3590, J9999 when billing for ustekinumab-auub (Wezlana), biosimilar, intravenous

CMS has established a permanent procedure code for specialty medical drug ustekinumab-auub (Wezlana), biosimilar, intravenous, 1 mg.

All services through June 30, 2024, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2024, must be reported with Q5138.        

Prior authorization is required through the Medical Benefit Drug Program for Q5138 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.

J3393 replaces C9399, J3490, J3590, J9999 when billing for Zynteglo (betibeglogene autotemcel)

CMS has established a permanent procedure code for specialty medical drug Zynteglo™ (betibeglogene autotemcel).

All services through June 30, 2024, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2024, must be reported with J3393.

Prior authorization is required through the Medical Benefit Drug Program for J3393 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.

J3394 replaces C9399, J3490, J3590, J9999 when billing for Lyfgenia (lovotibeglogene autotemcel)

CMS has established a permanent procedure code for specialty medical drug Lyfgenia™ (lovotibeglogene autotemcel).

All services through June 30, 2024, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2024, must be reported with J3394.

Prior authorization is required through the Medical Benefit Drug Program for J3394 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.

J7171 replaces C9167, C9399, J3490, J3590, J9999 when billing for ADAMTS13 (recombinant-krhn)

CMS has established a permanent procedure code for specialty medical drug ADAMTS13 (recombinant-krhn).

All services through June 30, 2024, will continue to be reported with codes C9167, C9399, J3490, J3590 and J9999. All services performed on and after July 1, 2024, must be reported with J7171.

Procedure code C9167 was deleted effective June 30, 2024, and replaced with J7171.

Prior authorization is required through the Medical Benefit Drug Program for J7171 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.

J3247 replaces C9166 when billing for Cosentyx (secukinumab)

CMS has established a permanent procedure code for specialty medical drug Cosentyx^® (secukinumab).

All services through June 30, 2024, will continue to be reported with C9166. All services performed on and after July 1, 2024, must be reported with J3247.

Prior authorization is required through the Medical Benefit Drug Program for J3247 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.

J2470 replaces C9113 when billing for pantoprazole sodium, injection

CMS has established a permanent procedure code for specialty medical drug pantoprazole sodium, injection.

All services through June 30, 2024, will continue to be reported with C9113. All services performed on and after July 1, 2024, must be reported with J2470.

Procedure code C9113 was deleted June 30, 2024, and replaced with J2470.

J2471 replaces C9113 when billing for pantoprazole (hikma), injection, not therapeutically equivalent to J2470

CMS has established a permanent procedure code for specialty medical drug pantoprazole (hikma), injection, not therapeutically equivalent to J2470.

All services through June 30, 2024, will continue to be reported with C9113. All services performed on and after July 1, 2024, must be reported with J2471.

Procedure code C9113 was deleted June 30, 2024, and replaced with J2471.

J2267 replaces C9168 when billing for Omvoh

CMS has established a permanent procedure code for specialty medical drug Omvoh™.

All services through June 30, 2024, will continue to be reported with code C9168. All services performed on and after July 1, 2024, must be reported with J2267.

Procedure code C9168 was deleted June 30, 2024, and replaced with J2267.