INSIDE THIS ISSUE
-New Clinical and Billing Information
-Removal of NOC flag from J1599 and reinstatement of code price coming next month
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 71 AWP Drug Code Price changes this month, 21 (30%) 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:
- J1940 Injection, furosemide, up to 20 mg, 25%
- J2469 Injection, palonosetron HCl, 25 mcg, 25%
- S0179 Megestrol acetate, oral 20 mg, 25%
- J0698 Cefotaxime sodium, per gram, 275%
- Q4140 BioDFence, per square centimeter (Code Price based on Median pricing methodology), 43%
- J2001 Injection, lidocaine HCL for intravenous infusion, 10 mg, 25%
Check back next month for any pertinent updates from 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.
Removal of NOC flag from J1599 and reinstatement of code price coming next month
The committee met internally this month regarding the crosswalk for J1599 – Injection, immune globulin, intravenous, non-lyophilized (e.g. liquid), not otherwise specified, 500 mg. This HCPCS code is currently flagged as a Not Otherwise Classified (NOC) code in our data. However, now that Panzyga is the only drug cross-walked to this code, it was determined that a code price should be reinstated for our June 1 update. This will also cause this HCPCS to move from the NOC tab to the NDC crosswalk tab in our data files as well. We are notifying clients one month ahead of time to prepare for this change.
Drug Reimbursement Code Price Updates:
This month, during our review of the 3079 Reimbursement HCPCS/CPT® Codes in our system, we identified 71 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.
E0607 J1940 J7040 J9307 Q4138
J0185 J1943 J7050 J9371 Q4140
J0221 J2001 J7060 Q0161 Q4148
J0278 J2310 J7070 Q2041 Q4155
J0360 J2315 J7314 Q2050 Q4156
J0693 J2469 J8520 Q2053 Q4166 B4103 J0698 J2543 J8521 Q4104
B4150 J0775 J2597 J9032 Q4105
B4185 J0834 J2786 J9171 Q4108
C9353 J1301 J3145 J9177 Q4110
C9356 J1652 J3380 J9226 Q4114
C9363 J1790 J3410 J9271
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 which needed to be added to our database and four drugs that required updating.
ABECMA™ (idecabtagene vicleucel), suspension for intravenous infusion – By Celgene Corporation
FOTIVDA® (tivozanib) capsules, for oral use – By AVEO Pharmaceuticals, Inc.
LYSODREN® (mitotane) tablets, for oral use – By Corden Pharma Latina S.p.A.
LORBRENA® (lorlatinib) tablets, for oral use – By Pfizer
PRALUENT® (alirocumab) injection, for subcutaneous use – By Regeneron Pharmaceuticals, Inc.
TYMLOS® (abaloparatide) injection, for subcutaneous use – By Radius Health, Inc.
ZYPREXA IntraMuscular (olanzapine) Injection, Powder, For Solution for Intramuscular use – By Lilly USA
Our tools and data:
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