In first quarter 2022, the HCPCS Level II code set will get a refresh with several new, revised, and deleted codes.
According to the Centers for Medicare & Medicaid Services (CMS), there are:
155 new codes,
63 revised codes, and
48 deleted codes.
What These New Codes Report
The following codes were created per the request of third-party stakeholders after going through CMS’ standard HCPCS Level II code application process.
Q4199 – Cygnus matrix, per square centimeter
This is a new code for Cygnus™ Matrix, which is for “use as a wound covering or barrier in surgical, orthopedic, ophthalmic and wound applications,” according to the 2021 HCPCS Application Summary.
J9061 – Injection, amivantamab-vmjw, 2 mg
This code will replace HCPCS Level II code C9083, which is being discontinued on Dec. 31. This code reports RYBREVANT®, which is indicated for the treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). It is supplied as a single-dose 350 mg/7 mL (50 mg/mL) vial, according to the summary.
J9021 – Injection, asparaginase, recombinant, (rylaze), 0.1 mg
Rylaze™ is indicated as a component of a multi-agent chemotherapeutic regimen for the treatment of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL).
A9595 – Piflufolastat f-18, diagnostic, 1 millicurie
Piflufolastat F-18 is also known as PYLARIFY® and is for use as a positron emission tomography imaging agent.
J9272 – Injection, dostarlimab-gxly, 10 mg
This HCPCS Level II code will replace C9082, which is being discontinued on Dec. 31. Code J9272 reports Jemperli, which “is a programmed death receptor-1 (PD-1)-blocking antibody indicated for the treatment of adult patients with mismatch repair deficient (dMMR) recurrent or advanced endometrial cancer,” according to the summary.
J1952 – Leuprolide injectable, camcevi, 1 mg
This is a new code to report Camcevi®, which “is indicated for the treatment of adult patients with advanced prostate cancer,” the applicant states in the summary.
J0172 – Injection, aducanumab-avwa, 2 mg
This code is being added to identify ADUHELM® for the treatment of Alzheimer’s disease.
Q2055 – Idecabtagene vicleucel, up to 460 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
This HCPCS Level II code was created to identify ABECMA®, which is a B-cell maturation antigen (BCMA)-directed genetically modified autologous cell immunotherapy. “ABECMA is indicated for the treatment of adult patients with relapsed or refractory multiple myeloma after four or more prior lines of therapy,” per the summary.
Two new HCPCS Level II codes included in the first quarter 2022 update have a delated effective date.
Effective April 1, 2021:
G0465 Autologous platelet rich plasma (prp) for diabetic chronic wounds/ulcers, using an FDA-cleared device (includes administration, dressings, phlebotomy, centrifugation, and all other preparatory procedures, per treatment)
G0460 Autologous platelet rich plasma for non-diabetic chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment
Remember: The HCPCS Level II code set only identifies categories of items and services. The existence or absence of a HCPCS Level II code does not mean an item or service is covered or non-covered under Medicare. Check your payer policies and the National Correct Coding Initiative file for coverage indictors.
For more information, visit: https://www.aapc.com/blog/82869-learn-more-about-2022-hcpcs-level-ii-code-changes/