Specialty Drug Reimbursement – Newsletter – February 2019 – Volume 19, Issue 2


CMS News:

  • Home Infusion Therapy (HIT) Administration Codes are now Available

Drug Reimbursement Code Price Updates:

  • We review the reimbursement HCPCS/CPT® Codes in our system


  • New Clinical and Billing Information

Software Updates:

  • How to Locate a Drug Monograph


Large Price Changes:

We identify and report on the codes with the most substantial pricing increases or decreases each month and detail the rationale for the change.

Of the 192 AWP Drug Code Price changes this month, 21 (11%) were price decreases. The table in the Drug Reimbursement Code Price Updates section includes all AWP drug Code Price changes for this month. Please note:  These numbers represent AWP Code Price changes only. See below for examples of codes with significant price changes this month.



Price Decreases:

  • J1205 Injection, chlorothiazide sodium, per 500 mg: Decrease of 43%
  • J2800 Injection, methocarbamol, up to 10 mL: Decrease of 35%
  • S5561 Insulin delivery device, reusable pen; 3 mL size (Code Price is based on median pricing methodology): Decrease of 19% 

Price Increases:

  • J2795 Injection, ropivacaine hydrochloride, 1 mg: Increase of 120%
  • S0020 Injection, bupivacaine hydrochloride, 30 mL: Increase of 67%
  • J0735 Injection, clonidine hydrochloride, 1 mg: Increase of 30%

CMS News:

Home Infusion Therapy Administration Codes are Now Available

CMS has released new HCPCS® administration codes used for reimbursement of home infusion therapy (HIT) services for eligible home infusion suppliers. These can now be found in RJ Health’s data and cross-walked to codes assigned by CMS by accessing the Administration Codes module on ReimbursementCodes.com.  The three new G administration code descriptions can be found below.

For more information on the transitional payments for HIT services, please reference MLN Matters Article MM 10836 which can be found at the following hyperlink: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10836.pdf

G0068: Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, and/or inotropic infusion drug(s) for each infusion drug administration calendar day in the individual’s home, each 15 minutes

G0069: Professional services for the administration of subcutaneous immunotherapy for each infusion drug administration calendar day in the individual’s home, each 15 minutes

G0070: Professional services for the administration of chemotherapy for each infusion drug administration calendar day in the individual’s home, each 15 minutes


This month, during our review of the 3079 Reimbursement HCPCS/CPT® Codes in our system, we identified 192 Drug Codes that required a recalculation of their AWP Code Price. Log in to www.ReimbursementCodes.com to view the pricing updates for these codes.

90396 90746 B5200 J0480 J1568 J1931 J2502 J3090 J7200 J7605 J9145 J9295 Q4145
90620 90747 C9132 J0490 J1569 J1950 J2503 J3230 J7201 J7682 J9173 J9299 S0020
90621 90750 C9250 J0517 J1571 J1953 J2560 J3240 J7203 J7686 J9176 J9302 S0030
90632 A4230 C9254 J0597 J1573 J2170 J2562 J3357 J7205 J8670 J9179 J9303 S0088
90633 A4231 J0129 J0695 J1575 J2175 J2760 J3380 J7207 J9000 J9201 J9305 S0092
90636 A4232 J0180 J0712 J1602 J2182 J2783 J3396 J7211 J9023 J9202 J9307 S0109
90648 A4253 J0185 J0714 J1628 J2212 J2792 J3471 J7296 J9025 J9203 J9308 S0126
90670 A9513 J0202 J0716 J1640 J2260 J2794 J3489 J7297 J9032 J9205 J9325 S0128
90681 A9543 J0221 J0717 J1740 J2274 J2795 J7030 J7298 J9039 J9207 J9351 S0182
90690 A9587 J0256 J0735 J1750 J2278 J2796 J7181 J7301 J9040 J9216 J9352 S5553
90696 A9606 J0257 J0897 J1786 J2323 J2800 J7182 J7303 J9042 J9228 J9395 S5561
90700 B4102 J0270 J1205 J1826 J2353 J2810 J7183 J7325 J9043 J9229 Q0138 S5570
90715 B4153 J0295 J1438 J1830 J2425 J2860 J7189 J7511 J9045 J9262 Q0139
90723 B4154 J0360 J1439 J1833 J2426 J2941 J7192 J7525 J9047 J9264 Q3027
90744 B5100 J0475 J1555 J1930 J2501 J2993 J7198 J7527 J9055 J9285 Q3028


As new drugs come to market we review them for possible inclusion in our database. When a new drug is added to the database, we develop detailed clinical and billing information for the drug if appropriate.

During the past month, our review identified two new drugs which needed to be added to our database. Our review of existing drugs in our database with clinical and billing information already assigned identified six drugs that required updating.


GAMIFANT™ (emapalumab-lzsg) injection, for intravenous useby Sobi Inc.

ULTOMIRIS ™ (ravulizumab-cwvz) injection, for intravenous use- by Alexion Pharmaceuticals, Inc.


CABOMETYX® (cabozantinib) tablets, for oral use-by Exelixis, Inc.

  • Indications & Usage, ICD-10CM Codes, and Dosage & Administration

ANDEXXA® (coagulation factor Xa (recombinant), inactivated-zhzo) lyophilized powder for solution for intravenous injectionby Portola Pharmaceuticals, Inc.

  • Dosage & Administration

NATPARA® (parathyroid hormone) for injection, for subcutaneous use- by NPS Pharmaceutical,

  • Indications & Usage, ICD-10CM Codes, and Dosage & Administration

STRENSIQ® (asfotase alfa) injection, for subcutaneous use- by Alexion Pharmaceuticals, Inc.

  • Indications & Usage, ICD-10CM Codes, and Dosage & Administration

VORAXAZE® (glucarpidase) For Injection, for intravenous use- by BTG International Inc.,

  • ICD-10CM Codes

BENLYSTA® (belimumab) Injection, for subcutaneous use– by GSK Group of Companies

  • Indications & Usage   


At RJ Health we work hard to provide our customers with the most up to date information regarding drugs on the market, including creating and updating drug monographs to serve guides for drug administration and billing information.  Below is a reminder of where these drug monographs can be located for many of our NOC codes drug:

reimbursement codes rj health monograph feature button


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