Drug code changes in July's OPPS update
Q: Are there any new drug HCPCs codes for July?
A: CMS implemented one new HCPCS code effective July 1, Q9981 (rolapitant, oral, 1 mg). It is assigned status indicator K (nonpass-through drugs and biologicals) and to APC 1761.
In addition, CMS has granted pass-through status to five drugs and biologicals effective July 1:
- C9476, injection, daratumumab, 10 mg
- C9477, injection elotuzumab, 1 mg
- C9478, injection, sebelipase alfa, 1 mg
- C9479, instillation, ciprofloxacin otic suspension, 6 mg
- C9480, injection, trabectedin, 0.1 mg
CMS notes special reporting instructions for C9479:
Each vial of C9479 contains 60 mg or 10 doses. If one single-use vial is used for both patient’s ears, with the remainder of the drug in the vial unused, then two units of C9479 should be reported as administered to the patient; any discarded amount should be reported with the -JW modifier according to the Medicare Claims Processing Manual, Chapter 17 – Drugs and Biologicals, Section 40 – Discarded Drugs and Biologicals.
Two replacement HCPCS codes also become effective July 1:
- HCPCS code C9459 is being replaced with Q9982 (flutemetamol f18 diagnostic)
- HCPCS code C9458 is being replaced with Q9983 (florbetaben f18 diagnostic)
The status indicator has not changed for these codes; it remains G (additional payment for drug/biological pass-through). For more information, see Transmittal 3524.
Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.