J-Codes, Q-Codes, & C-Codes

C-code for Portrazza

A product‐specific C‐code has been assigned for Portrazza® (necitumumab) injection. The Centers for Medicare & Medicaid Services (CMS) released the April 2016 Update of the Hospital Outpatient Prospective Payment System (OPPS), which included designation of C9475 for Portrazza with the effective date of April 1, 2016.


Trade Name

HCPCS Code

Strength

NDC

CMS Long Descriptor

Effective Date

Portrazza

C9475

800 mg/50 mL (16 mg/mL)

00002-7716-01*

Injection, necitumumab, 1mg

April 1, 2016

*Note that the product’s NDC code has been “zero‐filled” to ensure creation of an 11‐digit code that meets CMS standards.

The zero‐fill location is indicated in bold.

HCPCS=Healthcare Common Procedure Coding System; NDC=National Drug Code.

Portrazza was approved by the US Food and Drug Administration on November 24, 2015. Portrazza is an epidermal growth factor receptor (EGFR) antagonist indicated, in combination with gemcitabine and cisplatin, for first-line treatment of patients with metastatic squamous non-small cell lung cancer (NSCLC). Portrazza is not indicated for the treatment of nonsquamous NSCLC.


PROLONGED DRUG AND BIOLOGICAL INFUSIONS STARTED INCIDENT TO A PHYSICIAN'S SERVICE USING AN EXTERNAL PUMP

This article is intended to provide the coding direction allowed to the MAC in MLN Matters®article SE1609: Medicare Policy Clarified for Prolonged Drug and Biological Infusions Started Incident to a Physician's Service Using an External Pump which is cited verbatim (in part) below:

“Medicare’s payment for the administration of the drug or biological billed to the MAC will also include payment for equipment used in furnishing the service. Equipment, such as an external infusion pump used to begin administration of the drug or biological that the patient takes home to complete the infusion, is not separately billable as durable medical equipment for a drug or biological paid under the section 1861(s)(2)(A) and (B) incident to benefit. The MAC may direct use of a code described by CPT or an otherwise applicableHCPCS code for the drug administration service. If necessary, the MAC may direct use of a miscellaneous code for the drug administration if there is no specified code that describes the drug administration service that also accounts for the cost of equipment that the patient takes home to complete the infusion that they later return to the physician or hospital.”

National Government Services has determined that the administration and pump charge should be reported under CPT code 96549 in addition to the HCPCS code for the chemotherapeutic agent provided. Under the incident to benefit, the physician must incur the cost of the drug. The allowance for CPT code 96549 will be considered all-inclusive for the chemotherapy administration and the pump. Therefore, no other administration, pump charge, set up or disconnect charges will be allowed. Providers should not report CPT code 96416, supplies, or pump code, (i.e., HCPCS code E0781).

Posted 5/5/2016



Biosimilar Modifier

The table below lists the current biosimilar HCPCS Codes, the product(s) that are associated with each code and the corresponding required modifier that is used to identify the product. The table will be updated quarterly when new permanent HCPCS codes and modifiers are available for biosimilar products that appear on the ASP price file.

Biosimilar HCPCS Code Product Brand names Corresponding Required Modifier

Q5101 Injection, Filgrastim (G-CSF),

Biosimilar, 1 microgram

Zarxio ZA- Novartis/Sandoz
          

HCPCS code for BLINCYTO® (blinatumomab) for injection for intravenous use. 

The Centers for Medicare & Medicaid Services (CMS) assigned a HCPCS code for BLINCYTO® which became effective on January 1, 2016.

HCPCS Code

BLINCYTO Long Descriptor

Effective Date

J9039

Injection, blinatumomab, 1mcg

1/1/2016


1/1/2016

Source: Centers for Medicare and Medicaid Services Alpha-Numeric HCPCS File

Source Link: CMS 2016 Alpha-Numeric HCPCS File


Permanent J-Code for Keytruda

The Center for Medicare and Medicaid Services (CMS) has assigned a permanent J-Code for KEYTRUDA. Effective January 1, 2016, the permanent J code for KEYTRUDA is J9271 Injection, Pembrolizumab, 1 mg. This means for dates of service on or after January 1, 2016 claims should be coded as “J9271 Injection, Pembrolizumab, 1 mg


New HCPCS Code for ramucirumab


The new code, J9308, is defined as Injection, ramucirumab, 5 mg. This code is effective January 1, 2016.  

Trade Name

HCPCS Code1

Strength

NDC*

CYRAMZA

J9308 Injection, ramucirumab, 5 mg

100 mg/10 mL (10 mg/mL)

500 mg/50 mL (10 mg/mL)

00002-7669-01

00002-7678-01

*NDC has been “zero-filled” to ensure creation of an 11-digit code that meets HIPAA standards. The zero-fill location is indicated in bold. HIPAA=Health Insurance Portability and Accountability Act.

Unique C Code for BLINCYTO

Effective April 1, 2015, BLINCYTO has been assigned a unique HCPCS C-code, C9449.


HCPCS Code

BLINCYTO Long Descriptor

Strength

Effective Date

C9449

Injection, blinatumomab, 1 mcg

35 mcg

4/1/2015


Source: April 2015 Update to the Hospital Outpatient Prospective Payment System (OPPS)

Source Link: http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Downloads/C-Codes-Effective-04-01-15.zip

Level II HCPCS C CODE FOR KEYTRUDA

Effective January 1, 2015, KEYTRUDA has been assigned a Level II HCPCS Code C9027 for Medicare hospital outpatient claims.

http://www.merckaccessprogram-keytruda.com/

http://www.merck.com/product/usa/pi_circulars/k/keytruda/keytruda_pi.pdf

PERMANENT J-CODE FOR  GAZYVA

Centers for Medicare & Medicaid Services (CMS) has granted a permanent J-code for GAZYVA® (obinutuzumab) that goes into effect January 1, 2015. The J-code for GAZYVA is J9301 (injection, obinutuzumab, 10 mg).


If you have any questions or concerns regarding billing and coding for GAZYVA, you can seek assistance from one of the dedicated Specialists at GAZYVA Access Solutions at (888) 249‐4918, or visit Genentech-Access.com/GAZYVA for more information.

 


UNIQUE C-CODE FOR GAZYVA
The Centers for Medicare & Medicaid Services (CMS) has granted a unique C-code for GAZYVA™ (obinutuzumab). The C-code for GAZYVA is C9021 (injection, obinutuzumab, 10 mg). The C-code goes into effect on April 1, 2014, and should be used until a permanent J-code is assigned. If granted, the permanent J-code is expected to be available for use starting January 1, 2015.

The C-code is used primarily in the Medicare hospital outpatient setting. However, some payers accept this C-code instead of the unclassified J- or C-codes when billing for GAZYVA. Please check with your payers to verify codes and special billing requirements. You can seek assistance from one of the dedicated Specialists at GAZYVA Access Solutions at (888) 249‐4918, or visit Genentech-Access.com/GAZYVA for more information.



J-CODES NOW AVAILABLE FOR ANTI-HER2 MBC THERAPIES


The Centers for Medicare & Medicaid Services (CMS) have granted KADCYLA® (ado-trastuzumab emtansine) and PERJETA® (pertuzumab) permanent J-codes that go into effect January 1, 2014. The J-code for KADCYLA is J9354 (injection, ado-trastuzumab emtansine, 1 mg) and the J-code for PERJETA is J9306 (injection, pertuzumab, 1 mg). http://www.cgsmedicare.com/jc/pubs/news/2013/1213/cope24092.html

Please be sure to prepare your systems for the introduction of these 2 new codes.

For additional assistance, you can contact one of the dedicated Specialists at Genentech BioOncology™ Access Solutions at (888) 249‐4918, or visit
http://www.genentech-access.com/biooncology/hcp for more information

NEW HCPCS CODE FOR ZALTRAP

Effective January 1, 2014, a new HCPCS code for Zaltrap (ziv-aflibercept) has been assigned by CMS.

J9400 Injection, ziv-aflibercept, 1 mg

This new HCPCS code replaces the HCPCS code of J9999.

• For additional details relative to this change, please visit:
http://www.cgsmedicare.com/jc/pubs/news/2013/1213/cope24092.html

For full prescribing Information on Zaltrap, visit www.zaltrap.com




NEW HCPCS code for Kyprolis 

Effective January 1, 2014, a new HCPCS code for Kyprolis® (carfilzomib) for Injection has been assigned by CMS.

The new code, J9047, is defined as “Injection, carfilzomib, 1mg”

• For additional details relative to this change, please visit:
http://www.cgsmedicare.com/jc/ pubs/news/2013/1213/ cope24092.html

View the KYPROLIS package insert at: http://kyprolis.com/.

New CMS HCPCS code for Neupogen® (filgrastim)

On November 29, 2013, CMS released the Healthcare Common Procedure Coding System (HCPCS) code set updates that will be effective January 1, 2014

  • Effective January 1, 2014, CMS has assigned a new HCPCS code for Neupogen®, J1442 injection, filgrastim 1 mcg.  This new HCPCS code replaces the old Neupogen® HCPCS codes of J1440 for 300 mcgs and J1441 for 480 mcgs.
  • As a result of the new Neupogen® HCPCS code, providers will need to enter the Neupogen® units used in the billing process to distinguish which Neupogen® dose was used (e.g. 300 mcg single use vial/prefilled syringe or 480 mcg single use vial/prefilled syringe).
  • For additional details relative to this change, here is the CMS website:  http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html

 

For the full Prescribing Information on Neupogen® (filgrastim), please go to:

http://www.neupogen.com

 


To submit coding updates for posting consideration, forward to info@nnecos.org.

Northern New England Clinical Oncology Society
P.O. Box 643
Sandown, NH 03873-0643
Telephone (603) 887-1948
info@nnecos.org

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