INSIDE THIS ISSUE
-New Clinical and Billing Information
-New HCPCS® Codes Effective April 1, 2021 Now Available
Large Price Changes:
We identify and report on the codes with the most substantial pricing increases or decreases each month and detail the rationale for the change.
Of the 52 AWP Drug Code Price changes this month, 22 (42%) were price decreases. The table in the Drug Reimbursement Code Price Updates section includes all AWP drug Code Price changes for this month. Please note: These numbers represent AWP Code Price changes only. See below for examples of codes with significant price changes this month.
LOOK UP PRICES NOW:
- S0194 Dialysis/stress vitamin supplement, oral, 100 capsules, 73%
- J7510 Predisone, oral, per 5 mg, 69%
- JJ088 Injection, daptomycin, 1 mg, 35%
- J2270 Injection, morphine sulfate, up to 10 mg (Code Price is per 10 mg), 16%
- J9216 Injection, interferon, gamma-1b, 3 million units, 15%
- J1270 Injection, doxercalciferol, 1 mcg, 14%
New HCPCS® Codes Effective April 1, 2021 Now Available
CMS (Centers for Medicare and Medicaid) did not release the quarterly file for New, Deleted, and Revised HCPCS® codes in time for RJ Health’s March update. Included in the data this month are the new HCPCS® codes effective for billing April 1, 2021 that were obtained from the Fourth Quarter Application Summary and Coding Decisions meeting minutes. Our system will be updated with any other additions, deletions, or revisions when the quarterly file is released by CMS. The codes that have been added to our data are listed below. Follow this link to view the full meeting minutes: https://www.cms.gov/files/document/2020-hcpcs-application-summary-quarter-4-2020-drugs-and-biologics.pdf
New HCPCS® Codes:
A9592 – Copper Cu-64, dotatate, diagnostic, 1 millicurie
J1427 – Injection, viltolarsen, 10 mg
J1554 – Injection, immune globulin (asceniv), 500 mg
J7402 – Mometasone furoate sinus implant, (sinuva), 10 micrograms
J9037 – Injection, belantamab mafodontin-blmf, 0.5 mg
J9349 – Injection, tafasitamab-cxix, 2 mg
Q2053 – Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose (Code Price is for drug only)
S1091 – Stent, non-coronary, temporary, with delivery system (propel)
Each month the RJ Health Clinical Committee meets to review newly approved drugs, dosing, ICD-10 assignments, coding assignments and billable units. Additionally, we discuss questions and concerns our customers raise to ensure we are providing the most accurate and current information in our data and on our website.
Drug Reimbursement Code Price Updates:
This month, during our review of the 3079 Reimbursement HCPCS/CPT® Codes in our system, we identified 52 Drug Codes that required a recalculation of their AWP Code Price. Log in to www.ReimbursementCodes.com to view the pricing updates for these codes.
90291 E0607 J1270 J3095 J9047 S0194 90396 E2100 J1438 J3111 J9119 S8490 A4213 J0604 J1455 J3411 J9209 A4253 J0743 J1650 J3415 J9216 A4259 J0744 J1741 J7050 J9303 A4627 J0770 J2270 J7507 J9325 A7015 J0850 J2310 J7510 J9360 B4160 J0878 J2440 J7517 Q0161 B4162 J0897 J2507 J9039 Q4174 C9488 J1100 J2796 J9045 S0119
LOOK UP PRICES NOW:
Drugs/Devices: New/Updated Billing & Clinical Information
As new drugs come to market we review them for possible inclusion in our database. When a new drug is added to the database, we develop detailed clinical and billing information for the drug if appropriate.
During the past month, our review identified six new drugs which needed to be added to our database and three drugs that required updating.
BREYANZI® (lisocabtagene maraleucel) suspension for intravenous infusion – By Juno Therapeutics Inc., a Bristol-Myers Squibb Company
CABENUVA (cabotegravir extended-release injectable suspension; rilpivirine extended-release injectable suspension), co-packaged for intramuscular use – By ViiV Healthcare
COSELA™ (trilaciclib) for injection, for intravenous use – By G1 Therapeutics, Inc
EVKEEZA™ (evinacumab-dgnb) injection, for intravenous use – By Regeneron Pharmaceuticals, Inc.
TEPMETKO® (tepotinib) tablets, for oral use – By EMD Serono, Inc.
UKONIQ™ (umbralisib) tablets, for oral use – By TG Therapeutics, Inc.
AIMOVIG® (erenumab-aooe) injection, for subcutaneous use – By Amgen Inc.
KEVZARA® (sarilumab) injection, for subcutaneous use – By Sanofi-Aventis U.S. LLC
STIVARGA® (regorafenib) tablets, for oral use – By Bayer HealthCare Pharmaceuticals Inc.
Our tools and data:
© 2019 RJ Health Systems International, LLC. All rights reserved. This newsletter and its contents are copyright protected. No part of this newsletter may be reproduced in any manner by any means without written permission of RJ Health Systems International, LLC.
CPT copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.