INSIDE THIS ISSUE
- New Clinical and Billing Information
- 2020-2021 Influenza Vaccine Season NDCs Now Available
- J7304 Updated to NDC Level Pricing
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 75 AWP Drug Code Price changes this month, 20 (27%) 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.
LOOK UP PRICES NOW:
- J8521 Capecitabine, oral, 500 mg, 60%
- J7609 Albuterol, inhalation solution, compounded product, administered through DME, unit dose, 1 mg (Code Price is for active ingredient only and does not include compounding cost), 48%
- J0604 Cinacalcet, oral, 1 mg, (for ESRD on dialysis) (For billing prior to 1/1/18 use J8499),36%
- J7611 Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 1 mg (Code reinstated effective 4/1/2008), 71%
- S5012 5% dextrose with potassium chloride, 1000 mL, 62%
- J3030 Injection, sumatriptan, succinate, 6 mg (code may be used for Medicare when drug administered under direct supervision of a physician; not for use when drug is self-administered), 39%
Check back next month for updates from Centers for Medicare and Medicaid (CMS).
2020-2021 Influenza Vaccine Season NDCs Now Available
New NDCs for the 2020-2021 Flu Season are cross-walked to their appropriate CPT codes and are now available on www.ReimbursementCodes.com Click the following link for a comprehensive list of NDCs cross-walked this month: 2020-2021 Vaccine Flu Codes
Each month the RJ Health Clinical Committee meets to review newly approved drugs, dosing, ICD-10 assignments, coding assignments and billable units. Additionally, we discuss questions and concerns our customers raise to ensure we are providing the most accurate and current information in our data and on our website.
J7304 Updated to NDC Level Pricing
After an internal discussion by our clinical committee, it was decided to update J7304 to NDC level pricing now that a new product called Twirla® is available and cross-walked to this code. Appropriate reimbursement for this HCPCS® code will be based on NDC submitted.
Drug Reimbursement Code Price Updates:
This month, during our review of the 3079 Reimbursement HCPCS/CPT® Codes in our system, we identified 75 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.
LOOK UP PRICES NOW:
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 three new drugs that 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.
UPLIZNA™ (inebilizumab-cdon) injection, for intravenous use – By Viela Bio, Inc.
ZEPZELCA™ (lurbinectedin) for injection, for intravenous use – By Jazz Pharmaceuticals, Inc.
PHESGO™ (pertuzumab, trastuzumab, and hyaluronidase-zzxf) injection, for subcutaneous use – By Genentech, Inc.
DUPIXENT® (dupilumab) injection, for subcutaneous use – By Regeneron Pharmaceuticals, Inc.
ICLUSIG® (ponatinib) tablets, for oral use – By Takeda Pharmaceutical Company Limited
XPOVIO™ (selinexor) tablets, for oral use – By Karyopharm Therapeutics Inc.
TAZVERIK™ (tazemetostat) tablets, for oral use – By Epizyme, Inc.
COSENTYX® (secukinumab) for injection, for subcutaneous use – By Novartis Pharmaceuticals Corporation
KINERET® (anakinra) for injection, for subcutaneous use – By Swedish Orphan Biovitrum AB (publ)
Our tools and data:
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