Category Archives: Educational Resources

In November there were 9 new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were 2 supplemental drug approvals. The FDA had acted on assignment of 7 new product reviews. Drugs included in this review are generally regarded by the industry as specialty drugs.  Qualifiers may include anticipated […]

INSIDE THIS ISSUE CMS News New HCPCS® Codes Effective January 1, 2020 Now Available Deleted and Revised HCPCS® Codes Effective January 1, 2020 Coming Soon Drug Reimbursement Code Price Updates 39 Drug Codes required a recalculation of their AWP Code Price Drugs/Devices New Clinical and Billing Information CODE UPDATES Large Price Changes: We identify and report […]

$35 billion of drug-related revenue comes from healthcare provider offices. Health plans have established policies that require additional information, not just the HCPCS code. This additional information enables payors to differentiate between drugs that exist under the same billing codes. Recent claims analysis revealed a high degree of confusion from providers on what is required […]

INSIDE THIS ISSUE CMS News New HCPCS® Codes Effective January 1, 2020 Coming Soon Drug Reimbursement Code Price Updates 68 Drug Codes required a recalculation of their AWP Code Price Drugs/Devices New Clinical and Billing Information CODE UPDATES Large Price Changes: We identify and report on the codes with the most substantial pricing increases or decreases […]

In October there were 7 new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were 7 supplemental drug approvals. The FDA had acted on assignment of 3 new product reviews. Drugs included in this review are generally regarded by the industry as specialty drugs.  Qualifiers may include anticipated […]

The following questions were submitted by attendees during the most recent Quarterly Drug Coding, Reimbursement, and Pipeline Update Webinar for Q3 2019. or      Q:  On the “Pricing Updates” slide it shows that the majority of Code Price changes were increases, but the Medicare Allowable ASP price changes showed a majority which were decreases. Why […]

INSIDE THIS ISSUE CMS News 2019-2020 Influenza Vaccine Season NDCs Now Available New HCPCS Code J0642-Injection, levoleucovorin (khapzory), 0.5 mg and Revised Code Description for J0641-levoleucovorin, 0.5mg Coming Soon New HCPCS Drug Q-Codes effective October 1, 2019 New HCPCS Drug J-Codes effective October 1, 2019 New HCPCS Drug Code Revisions and Discontinuations effective October 1, […]

Join RJ’s Jason Young – SVP Clinical Data Operations, Todd Cooperman – SVP Clinical Insights and Analytics, and Chris Webb – Director of Product Development, as they review the drug coding updates, revisions, and issues observed over 2019’s third quarter. Learn about: New and Existing Code Updates – HCPCS Codes: J Codes, Q Codes •  […]

Wondering about the different types of HCPCS (Healthcare Common Procedure Coding System) codes and how they apply to reimbursement? Chris and Jason walk through HCPCS and CPT® (Current Procedural Terminology) code background in this edition of Drug Pricing and Reimbursement 101. These webinar clips from “Shedding Light on Medically Covered Specialty Drug Pricing Methods” touch […]

INSIDE THIS ISSUE CMS News 2019-2020 Influenza Vaccine Season NDCs Now Available New HCPCS Drug Q-Codes effective October 1, 2019 New HCPCS Drug J-Codes effective October 1, 2019 New HCPCS Drug Code Revisions and Discontinuations effective October 1, 2019 Drug Reimbursement Code Price Updates 48 Drug Codes required a recalculation of their AWP Code Price Drugs/Devices […]