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New Coding Guidance for Recently Approved Pfizer Oncology Product

The Centers for Medicare and Medicaid Services (CMS) has assigned the following Healthcare Common Procedure Coding System (HCPCS)* J-Code for ELREXFIO (elranatamab-bccm) injection effective for dates of service on or after April 1, 2024 J1323- Injection, elranatamab-bcmm, 1 mg Please see full prescribing information including Boxed Warning, HERE.

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Permanent J-Code Assigned for Pepaxto® (melphalan flufenamide)

INDICATION:   PEPAXTO is indicated in combination with dexamethasone for the treatment of adult patients with relapsed or refractory multiple myeloma who have received at least four prior lines of therapy and whose disease is refractory to at least one proteasome inhibitor, one immunomodulatory agent, and one CD38-directed monoclonal antibody. This indication is approved under […]

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IMFINZI® (durvalumab) injection has been assigned a unique HCPCS code by the Centers for Medicare & Medicaid Services (CMS).

AstraZeneca is pleased to announce that IMFINZI® (durvalumab) injection has been assigned a unique HCPCS code by the Centers for Medicare & Medicaid Services (CMS). Effective for dates of services on or after January 1, 2019, the following code can be used to identify IMFINZI® (durvalumab) when billing across settings of care as noted in […]

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BESPONSA™

Effective for dates of service on or after January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) has granted BESPONSA™ (inotuzumab ozogamicin) injection for IV infusion the following temporary Healthcare Common Procedure Coding System (HCPCS) C-Code*:  C9028 – injection, inotuzumab ozogamicin, 0.1 mg This update is about an important coding change for BESPONSA.   […]

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New HCPCS Code for Portrazza® (Necitumumab)

We are sending this communication on behalf of Eli Lilly and Company to announce the assignment of a product‐specific Healthcare Common Procedure Coding System (HCPCS) code for Portrazza® (necitumumab) for injection.                         The new code, J9295, is defined as “injection, necitumumab, 1 mg.” This code is effective January 1, 2017.1    Trade Name HCPCS Code […]

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New HCPCS Code for IMLYGIC® (Talimogene Laherparepvec)

INDICATION IMLYGIC is a genetically modified oncolytic viral therapy indicated for the local treatment of unresectable cutaneous, subcutaneous, and nodal lesions in patients with melanoma recurrent after initial surgery. IMLYGIC has not been shown to improve overall survival or have an effect on visceral metastases The new code, J9325, is defined as “injection, talimogene laherparepvec, […]

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Permanent J code for BENDEKA (bendamustine HCI) Injection

On November 1st 2016, the Center for Medicare and Medicaid Services (CMS) published the 2017 HCPCS Code set, which included a permanent, UNIQUE J code for BENDEKA® (bendamustine HCI) Injection. Effective January 1, 2017, the Permanent J code for BENDEKA® will be J 9034 Injection, bendamustine HCI (bendeka), 1 mg. Select “2017 Alpha-Numeric HSPCS file” […]

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Follow up to NEW CPT Code Associated with Neulasta® (pegfilgrastim) Onpro Kit

In order to set 2017 pricing for 96377, Amgen believes that commercial payers and Medicare Administrative Contractors should use a direct crosswalk to the payment rate for the subcutaneous CPT code 96372

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Announcing a unique C-code Assigned to TECENTRIQ™ (atezolizumab)

Dear Healthcare Provider, The following is important information regarding a unique C-code that was recently assigned to TECENTRIQ™ (atezolizumab) by the Centers for Medicare & Medicaid Services (CMS). The C-code for TECENTRIQ is C9483 (Injection, atezolizumab, 10 mg). The unique C-code goes into effect on October 1, 2016. Payers may require its use until a […]

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C‐code for Lilly Oncology Drug

Eli Lilly and Company announce the assignment of a product‐specific C‐code 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, 2016.1 Trade Name HCPCS Code […]

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