INSIDE THIS ISSUE
- New Clinical and Billing Information
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 63 AWP Drug Code Price changes this month, 17 (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:
- S0169 Calcitriol, 0.25 microgram, 67%
- A7005 Administration set, with small volume nonfiltered pneumatic nebulizer, nondisposable (Code Price is based on median pricing methodology), 58%
- Q0177 Hydroxyzine pamoate, 25 mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment, not to exceed a 48-hour dosage regimen (Indication not FDA-approved at this time), 40%
- A7015 Aerosol mask, used with DME nebulizer (Code Price is based on median pricing methodology), 104%
- J1200 Injection, diphenhydramine HCl, up to 50 mg, 49%
- J2795 Injection, ropivacaine hydrochloride, 1 mg, 44%
Check back next month for updates from Centers for Medicare and Medicaid Services (CMS).
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.
Drug Reimbursement Code Price Updates:
This month, during our review of the 3079 Reimbursement HCPCS/CPT® Codes in our system, we identified 63 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.
A4215 C9488 J1162 J3145 J9226 S0169 A4253 E0570 J1200 J3380 J9271 S0170 A4256 E0607 J1301 J7178 J9313 S4991 A4259 J0185 J1557 J7180 J9395 A6025 J0360 J1627 J7187 Q0138 A6248 J0364 J1644 J7202 Q0139 A7005 J0594 J2060 J7210 Q0177 A7015 J0604 J2786 J8520 Q4196 A9589 J0641 J2795 J9177 Q4254 B4103 J0692 J2800 J9185 Q9967 C9132 J0775 J2860 J9202 S0088 C9293 J0878 J3095 J9225 S0136
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 four new drugs which needed to be added to our database and two drugs that required updating.
FETROJA® (cefiderocol) for injection, for intravenous use – By Shionogi Inc.
VISTASEAL™ [Fibrin Sealant (Human)] – By Instituto Grifols, S.A
OTREXUPTM (methotrexate) injection, for subcutaneous use – By Antares Pharma, Inc.
PALYNZIQ® (pegvaliase-pqpz) injection, for subcutaneous use – By BioMarin Pharmaceutical
VENCLEXTA® (venetoclax tablets), for oral use – By AbbVie Inc.
Our tools and data:
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