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

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 CodeProduct Brand namesCorresponding Required Modifier

Q5101 Injection, Filgrastim (G-CSF),

Biosimilar, 1 microgram

ZarxioZA- Novartis/Sandoz
          

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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