INSIDE THIS ISSUE
Drug Reimbursement Code Price Updates
Drugs/Devices
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- New Clinical and Billing Information
CMS News
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- New, Revised, and Deleted HCPCS® Effective July 1, 2020
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CODE UPDATES
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 26 AWP Drug Code Price changes this month, 16 (62%) 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.
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Price Decreases:
- S5551 Insulin, most rapid onset (Lispro or Aspart); 5 units (Code Price is based on median pricing methodology), 31%
- J8610 Methotrexate, oral, 2.5 mg, 25%
- J1626 Injection, granisetron hydrochloride, 100 mcg, 25%
Price Increases:
- C9482 Injection, sotalol hydrochloride, 1 mg (For Hospital OPPS billing prior to 10/1/16 use C9399)
– see also J3490, 60% - S0109 Methadone, oral, 5 mg, 29%
- 90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen
content, for intramuscular use (Fluzone High-Dose is only indicated for those 65 years of age and older)
(Effective 6/1/2020 code Price is per 0.7 mL = 1 dose), 9%
CMS News:
New, Revised, and Deleted HCPCS® Effective July 1, 2020
CMS (Centers for Medicare & Medicaid Services) have released a set of new, revised, and deleted HCPCS® codes effective July 1, 2020. These codes will become billable on July 1st. The following is a list of codes that will be available and/or revised.
New HCPCS® Codes:
J0223 Injection, givosiran, 0.5 mg
J0591 Injection, deoxycholic acid, 1 mg
J0691 Injection, lefamulin, 1 mg
J0742 Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg
J0791 Injection, crizanlizumab-tmca, 5 mg
J0896 Injection, luspatercept-aamt, 0.25 mg
J1201 Injection, cetirizine hydrochloride, 0.5 mg
J1429 Injection, golodirsen, 10 mg
J1558 Injection, immune globulin (xembify), 100 mg
J3399 Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5×10^15 vector genomes
J7169 Injection, coagulation factor xa (recombinant), inactivated-zhzo (andexxa), 10 mg
J7204 Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
J7333 Hyaluronan or derivative, visco-3, for intra-articular injection, per dose
J9177 Injection, enfortumab vedotin-ejfv, 0.25 mg
J9198 Injection, gemcitabine hydrochloride, (infugem), 100 mg
J9246 Injection, melphalan (evomela), 1 mg
J9358 Injection, fam-trastuzumab deruxtecan-nxki, 1 mg
Q4227 Amniocore, per square centimeter
Q4228 Bionextpatch, per square centimeter
Q4229 Cogenex amniotic membrane, per square centimeter
Q4230 Cogenex flowable amnion, per 0.5 cc
Q4231 Corplex p, per cc
Q4232 Corplex, per square centimeter
Q4233 Surfactor or nudyn, per 0.5 cc
Q4234 Xcellerate, per square centimeter
Q4235 Amniorepair or altiply, per square centimeter
Q4236 Carepatch, per square centimeter
Q4237 Cryo-cord, per square centimeter
Q4238 Derm-maxx, per square centimeter
Q4239 Amnio-maxx or amnio-maxx lite, per square centimeter
Q4240 Corecyte, for topical use only, per 0.5 cc
Q4241 Polycyte, for topical use only, per 0.5 cc
Q4242 Amniocyte plus, per 0.5 cc
Q4244 Procenta, per 200 mg
Q4245 Amniotext, per cc
Q4246 Coretext or protext, per cc
Q4247 Amniotext patch, per square centimeter
Q4248 Dermacyte amniotic membrane allograft, per square centimeter
Q5119 Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg
Q5120 Injection, pegfilgrastim-bmez, biosimilar, (ziextenzo), 0.5 mg
Q5121 Injection, infliximab-axxq, biosimilar, (avsola), 10 mg
U0003 Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r
U0004 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r
Revised HCPCS® Codes:
J7321
Old Description: Hyaluronan or derivative, Hyalgan or Supartz or Visco-3, for intra-articular injection, per dose (Hyalgan dose is 20 mg/2 mL, Supartz and Visco-3 dose is 25 mg/2.5 mL) (Note: Total dose regimen = 3 – 5 injections)
New Description: Hyaluronan or derivative, hyalgan or supartz, for intra-articular injection, per dose
J9245
Old Description: Injection, melphalan hydrochloride, 50 mg
New Description: Injection, melphalan hydrochloride, not otherwise specified, 50 mg
Q4176
Old Description: NeoPatch, per square centimeter
New Description: Neopatch or therion, per square centimeter
Deleted HCPCS® Codes:
J9199 Injection, gemcitabine hydrochloride (infugem), 200 mg
There has been an update of the Hospital Outpatient Prospective Payment System (OPPS) through the addition and deletion of new HCPCS® Codes. These codes will be effective July 1st. The following is a list of codes which will be available, discontinued and/or revised for the July update:
New HCPCS® Codes:
C1748 Endoscope, single-use (i.e. disposable), upper gi, imaging/illumination device (insertable)
C1849 Skin substitute, synthetic, resorbable, per square centimeter
C9059 Injection, meloxicam, 1 mg
C9061 Injection, teprotumumab-trbw, 10 mg
C9063 Injection, eptinezumab-jjmr, 1 mg
C9122 Mometasone furoate sinus implant, 10 micrograms (sinuva)
C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source
Deleted HCPCS® Codes:
C9041 Injection, coagulation factor xa (recombinant), inactivated (andexxa), 10 mg
C9053 Injection, crizanlizumab-tmca, 1 mg
C9054 Injection, lefamulin (xenleta), 1 mg
C9056 Injection, givosiran, 0.5 mg
C9057 Injection, cetirizine hydrochloride, 1 mg
C9058 Injection, pegfilgrastim-bmez, biosimilar, (ziextenzo) 0.5 mg
Drug Reimbursement Code Price Updates:
This month, during our review of the 3079 Reimbursement HCPCS/CPT® Codes in our system, we identified 26 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.
90662 |
J8610 | C9482 | J1110 | Q9961 | WW068 |
90694 |
J8700 | E0570 | J1626 | S0109 | |
A4256 |
J9190 | E0607 | J1817 |
S5551 |
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A4357 | J9260 | J0153 | Q4206 |
S5571 |
|
A6196 | Q0169 | J0744 | Q9960 |
WW044 |
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Drugs/Devices: New/Updated Billing & Clinical Information
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 seven new drugs which needed to be added to our database and one drug that required updating.
New:
DARZALEX FASPRO™ (daratumumab and hyaluronidase-fihj) injection, for subcutaneous use – by Janssen Biotech, Inc.
TABRECTATM (capmatinib) tablets, for oral use – by: Novartis Pharmaceuticals Corp
RETEVMOTM (selpercatinib) capsules, for oral use – By: Eli Lilly and Company
REMDESIVIR (GS-5734™) for injection, for intravenous use – By: Gilead
DURYSTATM (bimatoprost implant), for intracameral administration – By: Allergan
JELMYTO™ (mitomycin) for pyelocalyceal solution – By: UroGen Pharma, Inc.
QINLOCK™ (ripretinib) tablets, for oral use – By: Deciphera Pharmaceuticals, LLC
Updated:
AKOVAZ™ (ephedrine sulfate injection, USP) for intravenous use – by Avadel Legacy Pharmaceuticals, LLC
DEFITELIO® (defibrotide sodium) injection, for intravenous use – by Jazz Pharmaceuticals, Inc
REBLOZYL® (luspatercept-aamt) for injection, for subcutaneous use – by Celgene Corporation
VERZENIO® (abemaciclib) tablets, for oral use – by Eli Lilly and Company
Our tools and data:
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