October HCPCS update brings 44 new drug codes

CMS added 44 new HCPCS drug and biological codes as part of its October quarterly update, with each code effective October 1.

Several new codes were added for injections and skin substitutes. A few new HCPCS codes include:

• J0121, injection, omadacycline (NUZYRA), 1 mg

This code identifies a tetracycline class antibacterial used to treat adult patients diagnosed with community-acquired bacterial pneumonia or acute bacterial skin infections, according to the FDA.

• J3111, injection, romosozumab-aqqg (EVENITY), 1 mg

This code identifies a sclerostin inhibitor used to treat osteoporosis in postmenopausal women at high risk for fracture, according to the FDA.

• Q4209, Surgraft per sq. cm

SurGraft is a human amniotic membrane scaffold that functions as a wound covering.

Medicare contractors should use Type of Service (TOS) 1 or TOS P when submitting claims for these services. For injection codes with more than one possible TOS designation, contractors should use either TOS P if the drug is administered through durable medical equipment or TOS 1 if the drug is administered in the office.

In addition to introducing many new codes as part of the October update, CMS is also discontinuing the following codes:  

• J1942, injection, aripiprazole lauroxil, 1 mg
• S1090, Mometasone furoate sinus implant, 370 micrograms

These codes may not be submitted on Medicare claims with dates of service on or after October 1.

Additional information on the October updates can be found in a September 17 issue of MLN Matters.