The HCPCS code set is updated quarterly. CR 11422 informs MACs and providers of the latest updates to specific drug/biological HCPCS codes. The October 2019 quarterly HCPCS file includes forty-four (44) new HCPCS codes. Effective for claims with dates of service on or after October 1, 2019.
1) J0121
a. Short Descriptor: Inj., omadacycline, 1 mg
b. Long Descriptor: Injection, omadacycline, 1 mg
c. Type of Service (TOS): 1,P
2) J0122
a. Short Descriptor: Inj., eravacycline, 1 mg
b. Long Descriptor: Injection, eravacycline, 1 mg
c. TOS: 1,P
3) J0222
a. Short Descriptor: Inj., patisiran, 0.1 mg
b. Long Descriptor: Injection, Patisiran, 0.1 mg
c. TOS: 1
4) J0291
a. Short Descriptor: Inj., plazomicin, 5 mg
b. Long Descriptor: Injection, plazomicin, 5 mg
c. TOS: 1
5) J0593
a. Short Descriptor: Inj., lanadelumab-flyo, 1 mg
b. Long Descriptor: Injection, lanadelumab-flyo, 1 mg (code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered)
c. TOS: 1
6) J1096
a. Short Descriptor: Dexametha opth insert 0.1 mg
b. Long Descriptor: Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
c. TOS: 1
7) J1097
a. Short Descriptor: Phenylep ketorolac opth soln
b. Long Descriptor: Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml
c. TOS: 1
8) J1303
a. Short Descriptor: Inj., ravulizumab-cwvz 10 mg
b. Long Descriptor: Injection, ravulizumab-cwvz, 10 mg
c. TOS: 1,P
9) J1943
a. Short Descriptor: Inj., aristada initio, 1 mg
b. Long Descriptor: Injection, aripiprazole lauroxil, (aristada initio), 1 mg
c. TOS: 1
10) J1944
a. Short Descriptor: Inj., aripirazole lauroxil 1 mg
b. Long Descriptor: Injection, aripiprazole lauroxil, (aristada), 1 mg
c. TOS: 1
11) J2798
a. Short Descriptor: Inj., perseris, 0.5 mg
b. Long Descriptor: Injection, risperidone, (perseris), 0.5 mg
c. TOS: 1,P
12) J3031
a. Short Descriptor: Inj., fremanezumab-vfrm 1 mg
b. Long Descriptor: Injection, fremanezumab-vfrm, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered)
c. TOS: 1, P
13) J3111
a. Short Descriptor: Inj. romosozumab-aqqg 1 mg
b. Long descriptor: Injection, romosozumab-aqqg, 1 mg
c. TOS: 1
14) J7314
a. Short Descriptor: Inj., yutiq, 0.01 mg
b. Long Descriptor: Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg
c. TOS: 1
15) J7331
a. Short Descriptor: Synojoynt, inj., 1 mg
b. Long Descriptor: Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg
c. TOS: 1
16) J7332
a. Short Descriptor: Inj., triluron, 1 mg
b. Long Descriptor: Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg
c. TOS: 1
17) J7401
a. Short Descriptor: Mometasone furoate sinus imp
b. Long Descriptor: Mometasone furoate sinus implant, 10 micrograms
c. TOS: 1
18) J9118
a. a. Short Descriptor: Inj. Calaspargase pegol-mknl
b. b. Long Descriptor: Injection, calaspargase pegol-mknl, 10 units
c. c. TOS: 1,P
19) J9119
a. Short Descriptor: Inj., cemiplimab-rwlc, 1 mg
b. Long Descriptor: Injection, cemiplimab-rwlc, 1 mg
c. TOS: 1
20) J9204
a. Short Descriptor: Inj, mogamulizumab-kpkc, 1 mg
b. Long Descriptor: Injection, mogamulizumab-kpkc, 1 mg
c. TOS: 1,P
21) J9210
a. Short Descriptor: Inj., emapalumab-lzsg, 1 mg
b. Long Descriptor: Injection, emapalumab-lzsg, 1 mg
c. TOS: 1
22) J9269
a. Short Descriptor: Inj. tagraxofusp-erzs 10 mcg
b. Long Descriptor: Injection, tagraxofusp-erzs, 10 micrograms
c. TOS: 1
23) J9313
a. Short Descriptor: Inj., lumoxiti, 0.01 mg
b. Long Descriptor: Injection, moxetumomab pasudotox-tdfk, 0.01 mg
c. TOS: 1,P
24) Q4205
a. Short Descriptor: Membrane graft or wrap sq cm
b. Long Descriptor: Membrane graft or membrane wrap, per square centimeter
c. TOS: 1
25) Q4206
a. Short Descriptor: Fluid flow or fluid gf 1 cc
b. Long Descriptor: Fluid flow or fluid GF, 1 cc
c. TOS: 1
26) Q4208
a. Short Descriptor: Novafix per sq cm
b. Long Descriptor: Novafix, per square centimeter
c. TOS: 1
27) Q4209
a. Short Descriptor: Surgraft per sq cm
b. Long Descriptor: Surgraft, per square centimeter
c. TOS: 1
28) Q4210
a. Short Descriptor: Axolotl graf dualgraf sq cm
b. Long Descriptor: Axolotl graft or axolotl dualgraft, per square centimeter
c. TOS: 1
29) Q4211
a. Short Descriptor: Amnion bio or axobio sq cm
b. Long Descriptor: Amnion bio or Axobiomembrane, per square centimeter
c. TOS: 1
30) Q4212
a. Short Descriptor: Allogen, per cc
b. Long Descriptor: Allogen, per cc
c. TOS: 1
31) Q4213
a. Short Descriptor: Ascent, 0.5 mg
b. Long Descriptor: Ascent, 0.5 mg
c. TOS: 1
32) Q4214
a. Short Descriptor: Cellesta cord per sq cm
b. Long Descriptor: Cellesta cord, per square centimeter
c. TOS: 1
33) Q4215
a. Short Descriptor: Axolotl ambient, cryo 0.1 mg
b. Long Descriptor: Axolotl ambient or axolotl cryo, 0.1 mg
c. TOS: 1
34) Q4216
a. Short Descriptor: Artacent cord per sq cm
b. Long Descriptor: Artacent cord, per square centimeter
c. TOS: 1
35) Q4217
a. Short Descriptor: Woundfix biowound plus xplus
b. Long Descriptor: Woundfix, BioWound, Woundfix Plus, BioWound Plus, Woundfix Xplus
or BioWound Xplus, per square centimeter
c. TOS: 1
36) Q4218
a. Short Descriptor: Surgicord per sq cm
b. Long Descriptor: Surgicord, per square centimeter
c. TOS: 1
37) Q4219
a. Short Descriptor: Surgigraft dual per sq cm
b. Long Descriptor: Surgigraft-dual, per square centimeter
c. TOS: 1
38) Q4220
a. Short Descriptor: Bellacell HD, Surederm sq cm
b. Long Descriptor: BellaCell HD or Surederm, per square centimeter
c. TOS: 1
39) Q4221
a. Short Descriptor: Amniowrap2 per sq cm
b. Long Descriptor: Amniowrap2, per square centimeter
c. TOS: 1
40) Q4222
a. Short Descriptor: Progenamatrix, per sq cm
b. Long Descriptor: Progenamatrix, per square centimeter
c. TOS: 1
41) Q4226
a. Short Descriptor: Myown harv prep proc sq cm
b. Long Descriptor: MyOwn skin, includes harvesting and preparation procedures, per square centimeter
c. TOS: 1
42) Q5116
a. Short Descriptor: Inj., trazimera, 10 mg
b. Long Descriptor: Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg
c. TOS: 1,P
43) Q5117
a. Short Descriptor: Inj., kanjinti, 10 mg
b. Long Descriptor: Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg
c. TOS: 1,P
44) Q5118
a.Short Descriptor: Inj., zirabev, 10 mg
b.Long Descriptor: Injection, bevacizumab-bvzr, biosimilar, (Zirabev), 10 mg
c. TOS: 1,P
HCPCS codes J1942 (Aripiprazole lauroxil 1mg/Injection, aripiprazole lauroxil, 1 mg) and S1090 (Mometasone sinus implant/Mometasone furoate sinus implant, 370 micrograms) are being discontinued effective October 1, 2019; and may not be used in submitting claims to Medicare with dates of service on or after that date.
Effective for claims with dates of service on or after October 1, 2019, the long and short descriptors for the following HCPCS codes will be modified. The TOS and all other indicators will remain the same.
1) J0641
a. New Short Descriptor: Inj., levoleucovorin, 0.5 mg
b. New Long Descriptor: Injection, levoleucovorin, 0.5 mg
2) J2794
a. New Short Descriptor: Inj., risperdal consta, 0.5 mg
b. New Long Descriptor: Injection, risperidone (risperdal consta), 0.5 mg
3) J7311
a. New Short Descriptor: Inj., retisert, 0.01 mg
b. New Long Descriptor: Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01
mg
9
4) J7313
a. New Short Descriptor: Inj., iluvien, 0.01 mg
b. New Long Descriptor: Injection, fluocinolone acetonide, intravitreal implant (Iluvien), 0.01
mg
5) Q4122
a. New Short Descriptor: Dermacell, awm, porous sq cm
b. New Long Descriptor: Dermacell, dermacell awm or dermacell awm porous, per square centimeter
6) Q4165
a. New Short Descriptor: Keramatrix, Kerasorb sq cm
b. New Long Descriptor: Keramatrix or kerasorb, per square centimeter
7) Q4184
a. New Short Descriptor: Cellesta or duo per sq cm
b. New Long Descriptor: Cellesta or cellesta duo, per square centimeter