HCPCS replacement codes established, effective April 1, 2024

C9166 replaces C9399 when billing for Cosentyx^® (secukinumab)

Effective April 1, 2024, the Centers for Medicare & Medicaid Services, or CMS, has established a permanent procedure code for the specialty medical drug Cosentyx (secukinumab).

Services can continue to be reported with C9399 through March 31, 2024. All services performed on and after April 1, 2024, must be reported with C9166.

C9168 replaces J3590 when billing for Omvoh™ (mirikizumab-mrkz)

Effective April 1, 2024, CMS has established a permanent procedure code for the specialty medical drug Omvoh (mirikizumab-mrkz).

Services can continue to be reported with J3590 through March 31, 2024. All services performed on and after April 1, 2024, must be reported with C9168.

J0177 replaces C9161, J3490, J3590 and J9999 when billing for Eylea^® HD (aflibercept)

Effective April 1, 2024, CMS has established a permanent procedure code for the specialty medical drug Eylea HD (aflibercept).

Services can continue to be reported with C9161, J3490, J3590 and J9999 through March 31, 2024. All services performed on and after April 1, 2024, must be reported with J0177.

J0589 replaces C9399, J3490, J3590 and J9999 when billing for Daxxify^® (daxibotulinumtoxinA-lanm)  
Effective April 1, 2024, CMS has established a permanent procedure code for the specialty pharmacy drug Daxxify (daxibotulinumtoxinA-lanm).

Services can continue to be reported with C9399, J3490, J3590 and J9999 through March 31, 2024. All services performed on and after April 1, 2024, must be reported with J0589.

J1323 replaces C9165 when billing for Elrexfio™ (elranatamab-bcmm)

Effective April 1, 2024, CMS has established a permanent procedure code for Elrexfio (elranatamab-bcmm).

Services can continue to be reported with C9165 through March 31, 2024. All services performed on and after April 1, 2024, must be reported with J1323.

J2782 replaces C9162, C9399, J3490, J3590 and J9999 when for billing IZERVAY™ (avacincaptad pegol)

Effective April 1, 2024, CMS has established a new procedure code for the specialty medical drug IZERVAY (avacincaptad pegol).                                                                             

All services through March 31, 2024, will continue to be reported with C9162, C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2024, must be reported with J2782.

Prior authorization is required through the Medical Benefit Drug program for J2782 for all groups unless they are opted out of the program. To determine whether a group participates in the prior authorization program, see the Specialty Pharmacy Prior Authorization Master Opt-in/out Group list.

For groups that have opted out of the prior authorization program, this code is covered for the FDA-approved indications.

J3055 replaces C9163 when billing for TALVEY™ (talquetamab-tgvs)

Effective April 1, 2024, CMS has established a new procedure code for the specialty medical drug TALVEY (talquetamab-tgvs).  

All services through March 31, 2024, will continue to be reported with C9163. All services performed on and after April 1, 2024, must be reported with J3055.

J7165 replaces C9159 when billing for BALFAXAR^® (prothrombin complex concentrate, human-lans)

Effective April 1, 2024, CMS has established a new procedure code for the specialty medical drug BALFAXAR (prothrombin complex concentrate, human-lans).                              

All services through March 31, 2024, will continue to be reported with C9159. All services performed on and after April 1, 2024, must be reported with J7165.

J7354 replaces C9164 when billing for YCANTH™ (cantharidin)

Effective April 1, 2024, CMS has established a new procedure code for the specialty medical drug YCANTH (cantharidin).

All services through March 31, 2024, will continue to be reported with C9164. All services performed on and after April 1, 2024, must be reported with J7354.

J9376 replaces C9399, J3490, J3590 and J9999 when billing for VEOPOZ™ (pozelimab-bbfg)

Effective April 1, 2024, CMS has established a new procedure code for the specialty medical drug VEOPOZ (pozelimab-bbfg).    

All services through March 31, 2024, will continue to be reported with C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2024, must be reported with J9376.

Prior authorization is required through the Medical Benefit Drug program for J9376 for all groups unless they are opted out of the program. To determine whether a group participates in the prior authorization program, see the Specialty Pharmacy Prior Authorization Master Opt-in/out Group list.

For groups that have opted out of the prior authorization program, this code is covered for the FDA-approved indications.

Q5133 replaces C9399, J3490, J3590 and J9999 when billing for TOFIDENCE™ (tocilizumab-bavi)

Effective April 1, 2024, CMS has established a new procedure code for the specialty medical drug TOFIDENCE (tocilizumab-bavi).                                                                             

All services through March 31, 2024, will continue to be reported with C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2024, must be reported with Q5133.

Prior authorization is required through the Medical Benefit Drug program for Q5133 for all groups unless they are opted out of the program. To determine whether a group participates in the prior authorization program, see the Specialty Pharmacy Prior Authorization Master Opt-in/out Group list.

For groups that have opted out of the prior authorization program, this code is covered for the FDA-approved indications.

Q5134 replaces C9399, J3490, J3590 and J9999 when billing for TYRUKO^® (natalizumab-sztn)

Effective April 1, 2024, CMS has established a new procedure code for the specialty medical drug TYRUKO (natalizumab-sztn). 

All services through March 31, 2024, will continue to be reported with code C9399, J3490, J3590 and J9999. All services performed on and after April 1, 2024, must be reported with Q5134.

Prior authorization is required through the Medical Benefit Drug program for Q5134 for all groups unless they are opted out of the program. To determine whether a group participates in the prior authorization program, see the Specialty Pharmacy Prior Authorization Master Opt-in/out Group list.

For groups that have opted out of the prior authorization program, this code is covered for the FDA-approved indications.