HCPCS replacement codes established, effective April 1, 2025

J9038 replaces C9399, J3490, J3590, J9999 when billing for Niktimvo™ (axatilimab-csfr)

Effective April 1, 2025, the Centers for Medicare & Medicaid Services, or CMS, has established a new procedure code for the specialty medical drug Niktimvo (axatilimab-csfr).        

All services through March 31, 2025, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2025, must be reported with J9038.

Prior authorization is required through the medical benefit drug program for J9038 for all groups unless they are opted out of this program. Reference the Prior Authorization Opt-In/Out Group list on availity.com.**

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

Q5147 replaces C9399, J3490, J3590, J9999 when billing for PAVBLU™ (aflibercept-ayyh)

Effective April 1, 2025, CMS has established a new procedure code for the specialty medical drug PAVBLU (aflibercept-ayyh).     

All services through March 31, 2025, will continue to be reported with codes C9399, J3490, J3590 and J9999.  All services performed on and after April 1, 2025, must be reported with Q5147.

Prior authorization is required through the medical benefit drug program for Q5147 for all groups unless they are opted out of this program. Reference the Prior Authorization Opt-In/Out Group list on availity.com.**

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

Q5148 replaces C9399, J3490, J3590, J9999 when billing for Nypozi^® (filgrastim-txid)

Effective April 1, 2025, CMS has established a new procedure code for the specialty medical drug Nypozi (filgrastim-txid). 

All services through March 31, 2025, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2025, must be reported with Q5148.

Prior authorization is required through the medical benefit drug program for Q5148 for all groups unless they are opted out of this program. Reference the Prior Authorization Opt-In/Out Group list on availity.com.**

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

Q5149 replaces C9399, J3490, J3590, J9999 when billing for Enzeevu™ (aflibercept-abzv)

Effective April 1, 2025, CMS has established a new procedure code for the specialty medical drug Enzeevu (aflibercept-abzv).     

All services through March 31, 2025, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2025, must be reported with Q5149.

Prior authorization is required through the medical benefit drug program for Q5149 for all groups unless they are opted out of this program. Reference the Prior Authorization Opt-In/Out Group list on availity.com.**

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

Q5152 replaces C9399, J3490, J3590, J9999 when billing for Bkemv™ (eculizumab-aeeb)

Effective April 1, 2025, CMS has established a new procedure code for the specialty medical drug Bkemv (eculizumab-aeeb).      

All services through March 31, 2025, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2025, must be reported with Q5152.

Prior authorization is required through the medical benefit drug program for Q5152 for all groups unless they are opted out of this program. Reference the Prior Authorization Opt-In/Out Group list on availity.com.**

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

Q9999 replaces C9399, J3490, J3590, J9999 when billing for Otulfi™ (ustekinumab-aauz)

Effective April 1, 2025, CMS has established a new procedure code for the specialty medical drug Otulfi (ustekinumab-aauz).

All services through March 31, 2025, will continue to be reported with codes C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2025, must be reported with Q9999.

Prior authorization is required through the medical benefit drug program for Q9999 for all groups unless they are opted out of this program. Reference the Prior Authorization Opt-In/Out Group at availity.com.**

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

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