INSIDE THIS ISSUE
-New Clinical and Billing Information
-New HCPCS® Codes Now Available
-New CPT® Codes Now Available
-Removal of NOC flag from J1599 and reinstatement of code price coming next month
-Update to A9591 Crosswalk
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 60 AWP Drug Code Price changes this month, 29 (48%) 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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- A4247 Betadine or iodine swabs/wipes, per box (Code Price is based on median pricing methodology)(Code Price is per each swab/wipe), 39%
- S0080 Injection, pentamidine isethionate, 300 mg, 63%
- J2469 Injection, palonosetron HCl, 25 mcg, 33%
- Q4208 Novafix, per square cenitmeter (Code Price is based on median pricing methodology), 78%
- Q4140 BioDFence, per square centimeter (Code Price based on Median pricing methodology), 43%
- A6248 Hydrogel dressing, wound filler, gel, per fluid ounce (Code Price is based on median pricing methodology), 25%
New, Revised, and Deleted HCPCS® Codes Now Available
CMS (Centers for Medicare & Medicaid Services) released their annual HCPCS® File for July 2021 which includes all New, Deleted, and Revised HCPCS® Codes. New codes have been added to www.ReimbursementCodes.com These codes became effective for Medicare billing for dates of service on and after July 1, 2021. All deleted codes will be updated in our data for July 1, 2021. We have provided a list of them to allow clients to prepare. CMS as not provided in revised codes yet in their file. Below is the list of new and deleted HCPCS® codes that RJ Health maintains in their database:
New HCPCS® Codes
A9593 Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie
A9594 Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurie
C9075 Injection, casimersen, 10 mg
C9076 Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
C9077 Injection, cabotegravir and rilpivirine, 2mg/3mg
C9078 Injection, trilaciclib, 1 mg
C9079 Injection, evinacumab-dgnb, 5 mg
C9080 Injection, melphalan flufenamide hydrochloride, 1 mg
C9778 Colpopexy, vaginal; minimally invasive extra-peritoneal approach (sacrospinous)
J0224 Injection, lumasiran, 0.5 mg
J1951 Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg
J7168 Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity
J9314 Injection, romidepsin, non-lyophilized (e.g. liquid), 0.1 mg
J9348 Injection, naxitamab-gqgk, 1 mg
J9353 Injection, margetuximab-cmkb, 5 mg
M0244 Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring the home or residence; this includes a beneficiary’s home that has been made provider based to the hospital during the covid 19 public health emergency
M0246 Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider based to the hospital during the covid 19 public health emergency
Q5123 Injection, rituximab-arrx, biosimilar, (riabni), 10 mg
Deleted HCPCS® Codes
C9065 Injection, romidepsin, non-lyophilized (e.g. liquid), 1mg
C9074 Injection, lumasiran, 0.5 mg
C9132 Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity
M0239 Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring
Q0239 Injection, bamlanivimab-xxxx, 700 mg
New CPT® Codes Now Available
The American Medical Association (AMA) released five new CPT® codes effective for billing on or after July 1, 2021. These codes have been added to www.ReimbursementCodes.com and are listed below:
90626 Tick-borne encephalitis virus vaccine, inactivated; 0.25 mL dosage, for intramuscular use
90627 0.5 mL dosage, for intramuscular use
90671 Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use
90677 Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use
90758 Zaire ebolavirus vaccine, live, for intramuscular use
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
As previously communicated, the committee met internally last month regarding J1599-Injection, immune globulin, intravenous, non-lyophilized (e.g. liquid), not otherwise specified, 500 mg. This HCPCS code was 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 could be reinstated. This change was made for our June update. This will also cause this HCPCS to move from the NOC tab to the NDC crosswalk tab in our data files as well.
Update to A9591 Crosswalk
This past month we received clarification from the manufacturer regarding the billable units for Cerianna in code A9591. It was confirmed that the billable units of the product needed to be updated in our data. We have changed the billable units for the Cerianna product from 100 to 6 per package. This update has resulted in a code price change. This code price is listed in our data as a new 6/1/2021 price, and we have retroactively updated the 1/1/2021 price to reflect this change in units.
Drug Reimbursement Code Price Updates:
This month, during our review of the 3079 Reimbursement HCPCS/CPT® Codes in our system, we identified 60 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.
90284 A6196 B4150 J1335 J3489 Q4133 A4216 A6203 B4152 J1453 J7050 Q4208 A4247 A6219 B4154 J1459 J7500 Q9966 A4253 A6220 B4155 J1559 J7510 Q9967 A4256 A6231 B4162 J1630 J8520 S0080 A4259 A6234 E0607 J1642 J8521 S0122 A4406 A6248 E2100 J2250 J9250 S0156 A4455 A6260 J0221 J2469 J9260 S0171 A4456 A9591 J0282 J2860 J9269 S5010 A5071 B4103 J0630 J3420 Q4117 S8490
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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 three 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 four drugs that required updating.
JEMPERLI (dostarlimab-gxly) injection, for intravenous use-By: GlaxoSmithKline LLC
ARTESUNATE for injection, for intravenous use- By Amivas LLC
ZYNLONTA™ (loncastuximab tesirine-lpyl) for injection, for intravenous use- By ADC Therapeutics
NEXIUM® I.V. (esomeprazole sodium) for injection, for intravenous use- By: AstraZeneca Pharmaceuticals LP
PROTONIX® I.V. (pantoprazole sodium) for injection, for intravenous use- By: Pfizer
SOTRADECOL® (Sodium Tetradecyl Sulfate Injection)-By: Mylan Institutional.
CUROSURF® (poractant alfa) intratracheal suspension-By Chiesi USA, Inc.
Our tools and data:
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