HCPCS replacement codes established, effective Jan. 1, 2025

J0139 replaces J0135 when billing HUMIRA^® (adalimumab)
Starting on Jan. 1, 2025, the Centers for Medicare & Medicaid Services has established a new procedure code for specialty medical drug HUMIRA (adalimumab).                          

All services can continue to be reported with code J0135 through Dec. 31, 2024. All services performed on and after Jan. 1, 2025, must be reported with J0139.

J0666 replaces C9290 when billing Exparel^® (bupivacaine liposome)
Effective Jan. 1, 2025, CMS has established a new procedure code for specialty medical drug Exparel (bupivacaine liposome).    

All facility services will continue to be reported with code C9290 through Dec. 31, 2024.  All services performed on and after Jan. 1, 2025, must be reported with J0666.

J0870 replaces C9399, J3490, J3590, J9999 when billing for Rytelo^® (imetelstat)
Effective Jan. 1, 2025, CMS has established a new procedure code for specialty medical drug Rytelo (imetelstat).   

All services will continue to be reported with code C9399, J3490, J3590 and J9999 through Dec. 31, 2024. All services performed on and after Jan. 1, 2025, must be reported with J0870.

Prior authorization is required through the Medical Benefit Drug Program for J0870 for all groups unless they are opted out of the program. Reference the Prior Authorization Opt-In/Out list at availity.com.**

For groups that have opted out of the program, this code is covered for the indications approved by the Food and Drug Administration.

J1307 replaces C9399, J3490, J3590, J9999 when billing for Piasky^® (crovalimab-akkz)
Effective Jan. 1, 2025, CMS has established a new procedure code for specialty medical drug Piasky (crovalimab-akkz).   

All services will continue to be reported with code C9399, J3490, J3590 and J9999 through Dec. 31, 2024. All services performed on and after Jan. 1, 2025, must be reported with J1307.

Prior authorization is required through the Medical Benefit Drug Program for J1307 for all groups unless they are opted out of the program. Reference the Prior Authorization Opt In/Out list at availity.com.**

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

J2802 replaces J2796 when billing Nplate^® (romiplostim)
Effective Jan. 1, 2025, CMS has established a new procedure code for specialty medical drug Nplate (romiplostim).

All services will continue to be reported with code J2796 through Dec. 31, 2024. All services performed on and after Jan. 1, 2025, must be reported with J2802.

J9026 replaces C9170 when billing Imdelltra^® (tarlatamab-dlle)
Effective Jan. 1, 2025, CMS has established a new procedure code for specialty medical drug Imdelltra (tarlatamab-dlle).

All facility services will continue to be reported with code C9170 through Dec. 31, 2024.  All services performed on and after Jan. 1, 2025, must be reported with J9026.

J9028 replaces C9169 when billing Anktiva^® (nogapendekin alfa inbakicept-pmln)
Effective Jan. 1, 2025, CMS has established a new procedure code for specialty medical drug Anktiva (nogapendekin alfa inbakicept-pmln).

All facility services will continue to be reported with code C9169 through Dec. 31, 2024.  All services performed on and after Jan. 1, 2025, must be reported with J9028.

Q5146 replaces C9399, J3490, J3590, J9999 when billing for Hercessi^® (trastuzumab-strf)
Effective Jan. 1, 2025, CMS has established a new procedure code for specialty medical drug Hercessi (trastuzumab-strf).

All services will continue to be reported with code C9399, J3490, J3590 and J9999 through Dec. 31, 2024. All services performed on and after Jan. 1, 2025, must be reported with Q5146.

Prior authorization is required through the Medical Benefit Drug Program for Q5146 for all groups unless they are opted out of the program. Reference the Prior Authorization Opt-In/Out list at availity.com.**

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

Q9996, Q9997 replace C9399, J3490, J3590, J9999 when billing for Pyzchiva^® (ustekinumab-ttwe)
Effective Jan. 1, 2025, CMS has established a new procedure code for specialty medical drug Pyzchiva (ustekinumab-ttwe).        

All services will continue to be reported with code C9399, J3490, J3590 and J9999 through Dec. 31, 2024. All services performed on and after Jan. 1, 2025, must be reported with Q9996 for subcutaneous administration and Q9997 for intravenous administration.

Prior authorization is required through the Medical Benefit Drug Program for Q9996 and Q9997 for all groups unless they are opted out of the program. Reference the Prior Authorization Opt-In/Out list at availity.com.**

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

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