Permanent J-Code for Halaven® (eribulin mesylate) Injection effective January 1, 2012
The Centers for Medicare & Medicaid Services (CMS) has assigned a permanent Healthcare Common Procedure Coding System (HCPCS) J-code for Halaven, J9179. This new code will replace both the temporary C-code used in the hospital outpatient setting as well as the miscellaneous HCPCS codes used in other settings, including J9999 and J3490.
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Unique HCPCS J-code for Halaven
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Description
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Billable units per
1 mg/2 mL single-dose vial
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J9179
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Injection, eribulin mesylate, 0.1 mg
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10
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J9179 can be used with all Medicare/Medicaid claims and most private commercial payors (coding requirements may vary).
Because Halaven has been issued a billing unit of 0.1 mg by CMS, providers wishing to bill for one single dose 1 mg/ 2 mL vial of Halaven may bill 10 units. Billing units can be reported in box 24G on the CMS-1500 claim form for physician offices and box 46 on the CMS-1450 (UB-04) claim form for the hospital outpatient department. J9179 can be reported in box 24D on the CMS-1500 claim form for physician offices and box 44 on the CMS-1450 (UB-04) claim form for the hospital outpatient department.
New J-Codes for Prolia® (denosumab) and XGEVA® (denosumab) effective January 1, 2012
The Centers for Medicare and Medicaid Services (CMS) have established a product-specific Healthcare Common Procedures Coding System (HCPCS) J-code, or permanent code, for Prolia® (denosumab) and XGEVA® (denosumab). Effective for dates of service on or after January 1, 2012, the new J-code for both Prolia® and XGEVA® is J0897.
The new J-code, J0897 for Prolia® and for XGEVA®, should be used instead of the current miscellaneous J-code (J3590) as well as the current C-code (C9272) when processing claims forms with dates of service on or after January 1, 2012.
Provenge Issued Q-code effective July 1, 2011 PROVENGE was issued a product specific Q-code, Q2043, effective July 1, 2011, which allows for electronic submission of claims and is expected to accelerate time to payment for physicians. The new code, Q2043, is for Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion. The NDC for PROVENGE remains the same: 30237-8900-06. Medicare will recognize Q2043 in the hospital outpatient and physician office settings.
Although coding requirements of other payers may vary, we expect some non-Medicare payers to recognize Q2043 in these settings as well.
Q2043 may replace other codes currently used to bill PROVENGE, including:
- C9273 (Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion)
- J3490 (Unclassified drugs)
- J3590 (Unclassified biologics)
- J9999 (Not otherwise classified, antineoplastic drugs)
New product EMEND® (fosaprepitant dimeglumine) for Injection 150 mg
The J-Code for EMEND® is J1453, injection, fosaprepitant dimeglumine, 1 mg.
Starting on December 30, 2010, Merck will discontinue sales of EMEND for Injection 115 mg. Over time, the supply of 115-mg vials at various wholesalers will diminish and, eventually, the 150-mg vial will be the only available packaging of EMEND for Injection.
Product-specific J-Code assigned for ISTODAX® (romidepsin) for injection: J9315
effective January 1, 2011
The new product-specific J-Code for ISTODAX is:
• J9315, injection, romidepsin, 1 mg
The new J-Code, J9315 for 1 mg of ISTODAX, replaces any temporary or miscellaneous codes
under which ISTODAX is currently reimbursed.
New FOLOTYN® J-Code assigned: J9307
CMS has issued J9307, a new national permanent Healthcare Common Procedure Coding System (HCPCS) J-code for FOLOTYN® (pralatrexate injection), effective for use on or after January 1, 2011. The temporary HCPCS code C9259 (injection, pralatrexate, 1 mg) will be deleted from the HCPCS effective December 31, 2010.
New Jevtana® (cabazitaxel) injection Calendar Year 2011 HCPCS Code: C9276
C9276 (Injection, cabazitaxel,1mg) should be used for Medicare coding for cabazitaxel in the hospital outpatient setting for dates of service on or after January 1, 2011. Other codes may be applicable for other payers and sites of service.
New Oforta™ (fludarabine phosphate tablets) Calendar Year 2011 HCPCS Code: J8562
While most providers currently report fludarabine phosphate tablets using a National Drug Code (NDC) and are expected to continue to do so, there are certain limited hospital outpatient Medicare billing scenarios where J8562 (Fludarabine phosphate oral, 10mg) should be reported for Medicare billing.
To submit coding updates for posting consideration, forward to info@nnecos.org.
