CMS establishes several permanent HCPCS procedure codes

The following HCPCS procedure codes became effective Oct. 1, 2019.

J0122 replaces J3490 when billing for Xerava (eravacycline)
The Centers for Medicare & Medicaid Services has an established permanent procedure code for Xerava (eravacycline).

All services from Aug. 27, 2018, through Sept. 30, 2019, will continue to be reported with procedure code J3490. All services performed on and after Oct. 1, 2019 must be reported with J0122.

Xerava (eravacycline) continues to be covered for the approved FDA indications as established on Aug. 27, 2018. Xerava is a tetracycline class antibacterial indicated for the treatment of complicated intra-abdominal infections in patients 18 years of age and older.

Pharmacy doesn’t require preauthorization for this drug.

J0222 replaces J3490, J3590 and C9036 for facility prior authorization when billing for Onpattro (patisiran)  

CMS has an established permanent procedure code for Specialty Medical Drug Onpattro (patisiran).
 
All services from Aug. 10, 2019, through Sept. 30, 2019, will continue to be reported with code J3490, J3590. All services performed on and after Oct. 1, 2019, must be reported with J0222.

All services from Jan. 1, 2019, through Sept. 30, 2019, for facility billing will continue to be reported with code C9036. All services performed on and after Oct. 1, 2019, must be reported with J0222.

Prior authorization is required through the Medical Benefit Drug Program for J0222 for all groups unless they opted out of the prior authorization program (professional and hospital outpatient facility SBP 15039).

The National Drug Code is 71336-1000-01.

Bypass prior authorization for all medical drugs procedure codes that require prior authorization submitted by a provider with a $0 charge.

Groups that have opted out of the Medical Benefit Drug Program require manual review.

J1303 replaces J3590 when billing Ultomiris (ravulizumab-cwvz)

CMS has established a permanent procedure code for specialty medical drug Ultomiris (ravulizumab-cwvz).

All services from Dec. 21, 2018, through Sept. 30, 2019, will continue to be reported with code J3590. All services performed on and after Oct. 1, 2019, must be reported with J1303.

All services from July 1, 2019, through Sept. 30, 2019, for facility billing will continue to be reported with code C9052. All services performed on and after Oct. 1, 2019, must be reported with J1303.

The NDC is 25682-0022-01.

Prior authorization is required through the Medical Benefit Drug Program for J1303 for all groups unless they opted out of the prior authorization program (professional and hospital outpatient facility SBP 15039).

Bypass prior authorization for all medical drugs procedure codes that require prior authorization submitted by a provider with a $0 charge.

Groups that have opted out of the Medical Benefit Drug Program require manual review.

J1943 and J1944 replace J3490 and C9035 facility when billing aripiprazole lauroxil, (aristada initio) and aripiprazole lauroxil, (aristada)

CMS has an established permanent procedure code for aripiprazole lauroxil, (aristada initio) and aripiprazole lauroxil, (aristada).

All services from June 25, 2018, through Sept. 30, 2019, will continue to be reported with code J3490. All services performed on and after Oct. 1, 2019, must be reported with J1943 and J1944.

All services from Jan. 1, 2019, through Sept. 30, 2019, for facility billing will continue to be reported with code C9035. All services performed on and after Oct. 1, 2019 must be reported with J1943 and J1944.

The NDC is 65757-0500-03.

Pharmacy doesn’t require prior authorization for this drug.

J3111 replaces J3490 and J3590 when billing Evenity (romosozumab-aqqg)

CMS has an established permanent procedure code for specialty medical drug Evenity (romosozumab-aqqg).

All services from April 1, 2019, through Sept. 30, 2019, will continue to be reported with code J3490 and J3590. All services performed on and after Oct. 1, 2019, must be reported with J3111.

The NDCs are 55513-0880-01 and 55513-0880-02.

Prior authorization is required through the Medical Benefit Drug Program for J1303 for all groups unless they opted out of the prior authorization program (professional and hospital outpatient facility SBP 15039).

Bypass prior authorization for all medical drugs procedure codes that require prior authorization submitted by a provider with a $0 charge.

Groups that have opted out of the Medical Benefit Drug Program require manual review.

J9204 replaces J3590 and C9038 when billing Poteligeo (mogamulizumab-kpkc)

CMS has established a permanent procedure code for specialty medical drug Poteligeo (mogamulizumab-kpkc).
 
All services from Aug. 8, 2018, through Sept. 30, 2019, will continue to be reported with code J3590. All services performed on and after Oct. 1, 2019, must be reported with J9204.

All services from Jan. 1, 2019, through Sept. 30, 2019, for facility billing will continue to be reported with code C9038. All services performed on and after Oct. 1, 2019, must be reported with J9204.

The NDC is 42747-0761-01.

Pharmacy doesn’t require preauthorization for this drug.