CPT Code Update 2019

Author: GDIT, (800) 688-6696

Effective with date of service Jan. 1, 2019, the American Medical Association (AMA) has added new CPT codes, deleted others and changed descriptions of some existing codes. For complete information regarding all CPT codes and descriptions, refer to the 2019 edition of Current Procedural Terminology, published by the AMA. Providers should note the full desriptions as well as all associated parenthetical information published in this edition when selecting a code for billing services to NC Medicaid.

New CPT codes that are covered by the NC Medicaid program are effective with date of service Jan. 1, 2019. Claims submitted with deleted codes will be denied for dates of service on or after Jan. 1, 2019. Previous policy restrictions continue in effect unless otherwise noted. This includes restrictions that may be on a deleted code that are continued with the replacement code(s).

HCPCS codes for Drugs Administered Other Than Oral Method (J Codes) are anticipated to be in NCTracks Jan. 6, 2019 retroactive to Jan. 1, 2019. Claims may be submitted prior to Jan. 6, 2019; however, claims will pend for “no rate on file” until rates and updates are complete. Covered codes are listed in a table at the end of this article.

New CPT Codes Covered by Medicaid and NCHC (effective Jan. 1, 2019)
10004	10005	10006	10007	10008	10009	10010	10011	10012	11102
11103	11104	11105	11106	11107	20932	20933	20934	27369	33285
33286	33440	33866	36572	36573	38531	43762	43763	50436	50437
76978	76979	77046	77047	77048	77049	92273	92274	95976	95977
95983	95984	96112	96113	96136	96137	96138	96139	96146

New HCPCS Codes Covered by Medicaid and NCHC (effective Jan. 1, 2019)
D1516	D1517	D5876	D9613	G2011	Q2042	Q4186	Q5108

The following codes for BRCA gene analysis and adaptive behavior treatment are still under review by NC Medicaid. Coverage determination and medical necessity criteria will be published at a later date:

New CPT Codes Still Under Review by Medicaid
81163	81164	81165	81166	81167	97151	97152	97153	97154	95155
97156	97157

New CPT Codes Not Covered by Medicaid and NCHC
99451	99452	99453	99454	99457	99491	33274	33275	33289	53854
76391	76981	76982	76983	81171	81172	81204	81173	81174	81177
81178	81179	81180	81181	81182	81183	81233	81184	81185	81186
81187	81188	81189	81190	81234	81239	81236	81237	81284	81285
81286	81289	81271	81274	81305	81306	81312	81320	81343	81329
81336	81337	81334	81345	81333	81443	81518	0018U	0019U	0020U
0021U	0022U	0023U	0024U	0025U	0026U	0027U	0028U	0029U	0030U
0031U	0032U	0033U	0034U	0035U	0036U	0037U	0038U	0039U	0040U
0041U	0042U	0043U	0044U	0045U	0046U	0047U	0048U	0049U	0050U
0051U	0052U	0053U	0054U	0055U	0056U	0057U	0058U	0059U	0060U
0061U	90689	93264	95836	97158

End-Dated CPT Codes (effective Dec. 31, 2018)
10022	11100	11101	20005	27370	31595	33282	33284	41500	43760
46762	50395	61332	61480	61610	61612	63615	64508	66220	76001
77058	77059	78270	78271	78272	92275	95974	95975	95978	95979
96101	96111	96118

End-Dated HCPCS Codes (effective Dec. 31, 2018)
D1515	J0833	J9310	Q2040	Q4131	Q5102	Q9993	Q9995

New J codes Effective Jan. 1, 2019	Description	Associated NDCs	HCPCS code End-dated Dec. 31, 2018
J0185	aprepitant injection (Cinvanti^TM) 1 mg	47426-0201-01	J3490
J0567	cerliponase alfa injection, for intraventricular use (Brineura®) 1 mg	68135-0811-02	J3590
J0584	burosumab-twza injection, for subcutaneous use (Crysvita®) 1 mg	69794-0102-01 69794-0203-01 69794-0304-01	J3590
J0841	crotalidae immune f(ab’)2 (equine), lyophilized powder for solution for injection for intravenous use (Anavip®) 120 mg	66621-0790-01 66621-0790-02	J3590
J1301	edaravone injection, for intravenous use (Radicava®) 1 mg	70510-2171-01 70510-2171-02	J3590
J1454	Fosnetupitant 235 mg and palonosetron 0.25 mg for injection, for intravenous use (Akynzeo®)	69639-0102-01	J3490
J1746	ibalizumab-uiyk injection, for intravenous use (Trogarzo™) 10 mg	62064-0122-02	J3590
J2797	rolapitant injection, emulsion for intravenous use (Varubi®) 0.5 mg	69656-0102-10	J3490
J3304	triamcinolone acetonide extended-release injectable suspension, for intra-articular use (Zilretta™) 1 mg	70801-0003-01	Q9993
J3316	triptorelin for extended-release injectable suspension, for intramuscular use (Triptodur™) 3.75 mg	24338-0150-20	J3490

New J codes

Effective Jan. 1, 2019

Description

Associated NDCs

HCPCS code End-dated Dec. 31, 2018

J3397

vestronidase alfa-vjbk injection, for intravenous use (Mepsevii™) 1 mg

69794-0001-01

J3590

J7170	emicizumab-kxwh injection, for subcutaneous use (Hemlibra®) 0.5 mg	50242-0920-01 50242-0921-01 50242-0922-01 50242-0923-01	Q9995
J7177	fibrinogen concentrate (human) lyophilized powder for reconstitution (Fibryga®) 1 mg	68982-0347-01 68982-0348-01	J3590
J7203	coagulation factor IX (recombinant), glycoPEGylated, lyophilized powder for solution for intravenous injection (Rebinyn®) 1 iu	00169-7901-01 00169-7902-01 00169-7905-01	J7199
J9057	copanlisib injection, for intravenous use (Aliqopa™) 1 mg	50419-0385-01	J9999
J9153	daunorubicin 1 mg and cytarabine 2.27 mg liposome injection, for intravenous use (Vyxeos™)	68727-0745-01 68727-0745-02 68727-0745-05	J9999
J9173	durvalumab injection, for intravenous use (Imfinzi®) 10 mg	00310-4500-12 00310-4611-50	J3590
J9229	inotuzumab ozogamicin injection, for intravenous use (Besponsa™) 0.1 mg	00008-0100-01	J9999
J9311	rituximab and hyaluronidase human injection, for subcutaneous use (Rituxan Hycela®) 10 mg	50242-0108-01 50242-0109-01	J9999
J9312	rituximab injection for intravenous use (Rituxan®) 10 mg	50242-0051-21 50242-0053-06	J9310

Note: All Category II and III Codes are not covered.

A bulletin article will be published listing the new codes that will be separately reimbursable by Ambulatory Surgery Centers (ASC) when that information is released by the Centers for Medicare & Medicaid Services (CMS) in January 2019.

Related Topics: