The Centers for Medicare and Medicaid Services (CMS) has released a summary of each HCPCS Level II code application decision. The document is twenty-eight pages long and the link can be found in the Resources section.
There are 23 items included in the Second Quarter 2024 Drug and Biological decisions. Twenty new codes have been established. There is one title revision and two code deletions.
| Title | Decision | HCPCS Code | Description |
| Docivyx | Title Revision | J9172 | Change manufacturer from Ingenus to Avyxa |
| Xenoview™ | Add | A9610 | Xenon xe-129 hyperpolarized gas, diagnostic, per study dose |
| Delete | J9150 | Xenon xe-129 hyperpolarized gas, diagnostic, per study dose | |
| Aurlumyn™ | Add | J1749 | Inj, iloprost, 0.1mcg |
| Combogesic ® | Add | J0138 | Inj, acetaminophen 10 mg and ibuprofen 3 mg |
| Paclitaxol Protein Bound Particles | Delete | J9258 | Inj, paclitaxel protein-bound particles (teva) not therapeutically equivalent to J9264, 1 mg. |
| Jubbonti & Wyost | Add | Q5136 | Inj, denosumab-bbdz, biosimilar, 1 mg |
| TYENNE ® | Add | Q5135 | Inj, tocilizumab-aazg, biosimilar, 1 mg |
| TEVIMBRA | Add | Q9329 | Inj, tislelizumab-jsgr, 1 mg |
| KISUNLA™ | Add | J0175 | Inj, donanemab-azbt, 2 mg |
| Baxter’s Vasopressin in Sodium Chloride | Add | J2601 | Inj, vasopressin (baxter), 1 unit |
| Tri-Membrane Wrap | Add | Q4344 | Tri-membrane wrap, per square centimeter |
| Dermacyte® AC Matrix Amniotic Membrane Allograph | Add | Q4343 | Dermatocyte ac matrix amniotic membrane allograph, per square centimeter |
| TheraMend | Add | Q4342 | Theramend, per square centimeter |
| Matrix HD Allograft Dermis | Add | Q4345 | Matrix hd allograft dermis, per square centimeter |
| Artacent C | Add | Q4336 | Artacent c, per square centimeter |
| Artacent Trident | Add | Q4337 | Artacent trident, per square centimeter |
| Artacent Velos | Add | Q4338 | Artacent velos, per square centimeter |
| Artacent VeriClen | Add | Q4339 | Artacent vericlen, per square centimeter |
| AmnioPlast 1 ™ | Add | Q4334 | Amnioplast 1, per square centimeter |
| AmnioPlast 2 ™ | Add | Q4335 | Amnioplast 2, per square centimeter |
| SimpliMax | Add | Q4341 | Simplimax, per square centimeter |
| SimpliGraft | Add | Q4340 | Simpligraft, per square centimeter |
It is recommended to review the application results to determine when the code becomes active or inactive.
There is also an analysis of HCPCS codes for products approved by the Food and Drug Administration (FDA) under the 505(b)(2) NDA and BLA Pathways and Products Not Otherwise Classified. The results are eight new codes, one revision, and four deletions as shown below:
The release of the application decisions means that the chargemaster coordinator must review the chargemaster to see if the changes impact the file.
Each of the added items should be discussed with the pharmacy department or chief medical officer (CMO) to determine if there is a plan to add these drugs and biologicals to the formulary. Pharmaceuticals can be difficult because of the translation that is made from the units described in the code description to the usual dosage amount.
The HCPCS codes are updated on a quarterly basis so this process should occur with each release. It is important to avoid unnecessary claim denials due to inactive codes or missed charges because the new codes are not available for reporting.
Resources:
2024-hcpcs-application-summary-quarter-2-2024-drugs-and-biologicals.pdf (cms.gov)
Artificial intelligence (AI) has revolutionized the way industries operate, and healthcare is no exception. Since the introduction of generative AI tools like large language models
Happy New Year! You may be planning on hitting the gym a little more frequently, or maybe you are hoping to lose a few pounds.
Please log in to your account to comment on this article.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
