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MYLOTARG™

Effective for dates of service on or after January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) has granted MYLOTARG™ (gemtuzumab ozogamicin) injection for IV infusion the following permanent Healthcare Common Procedure Coding System (HCPCS) J-Code*:  J9203 – injection, gemtuzumab ozogamicin, 0.1 mg We are respectfully requesting that you update your membership of […]

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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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CMS Finalizes Hospital Outpatient Prospective Payment System Changes to Better Support Hospitals and Physicians and Improve Patient Care

Nov 1, 2016, the Centers for Medicare & Medicaid Services (CMS) finalized updated payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2017.

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CMS Now Requires JW Modifier for Discarded Drug

The Centers for Medicare & Medicaid Services (CMS) released Transmittal 3508 that now requires the use of the JW modifier to report discarded drugs and biologicals from single use vials or single use packages. Previously, CMS Medicare Administrative Contractors (MACs) had the discretion to require the JW modifier on claims with discarded drugs. CMS will now […]

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300+ National & State Organizations Ask Congress: Stop the CMS Drug Payment Proposal!

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New HCPCS Code for BLINCYTO® (blinatumomab)

We are sending this communication on behalf of Amgen Inc. to inform you of the assignment of a 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 […]

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CMS Part B Biosimilar Biological Product Payment and Required Modifiers

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.  Please […]

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CMS Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2015 Update

As you are aware CMS releases quarterly code changes through the Medicare Learning Network/MLN Matters publications. Attached are the upcoming changes that will be in the July 1st update. HCPCS – Drug/Biological Code Changes – July 2015 Update CMS Manual System – Pub 100-04 Medicare Claims Processing Click Here to go to information that is […]

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