Effective with the date of service July 1, 2020, the Centers for Medicare and Medicaid Services (CMS) has added new HCPCS codes (J codes), deleted others, and changed the description of some existing codes.
NC Medicaid and GDIT have updated the NCTracks system to align our policies with HCPCS code (J code) changes (new codes, covered and non-covered, as well as the end-dated codes) to ensure that claims billed with the new codes will process and pay correctly.
Claims submitted with deleted codes will be denied for dates of service on or after July 1,2020. 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).
|
New HCPCS code (J codes) covered by Medicaid and NC Health Choice (effective 7/1/2020) |
Description |
Associated NDCs |
Old HCPCS code (Ineffective 6/30/2020) |
|
J7204 |
Injection, factor viii, antihemophilic factor (recombinant), glycopegylated-exei lyophilized powder for solution, for intravenous use (Esperoct®) |
00169-8500-01, 00169-8501-11, 00169-8100-01, 00169-8101-11, 00169-8150-01, 00169-8151-11, 00169-8200-01, 00169-8201-11, 00169-8300-01, 00169-8301-11 |
J7199 |
|
J1201 |
Injection, cetirizine hydrochloride, 0.5 mg (Quzyttir™) |
70720-0100-01, 70720-0100-25 |
J3490 |
|
J7169 |
Injection, coagulation factor xa (recombinant), inactivated-zhzo (Andexxa®), 10 mg
|
69853-0101-01, 69853-0102-01, 65757-0403-01, 65757-0403-03 |
J3590 |
|
J9177 |
Injection, enfortumab vedotin-ejfv, (Padcev™) 0.25 mg
|
51144-0020-01, 51144-0030-01 |
J9999 |
|
Q5120 |
Injection, pegfilgrastim-bmez, biosimilar, (Ziextenzo™), 0.5 mg. |
61314-0866-01 |
J3490 |
|
J9358 |
Injection, fam-trastuzumab deruxtecan-nxki, (Enhertu®) 1 mg
|
65597-0406-01
|
J9999 |
|
J0896 |
Injection, luspatercept-aamt, 0.25 mg (Reblozyl®) |
59572-0711-01, 59572-0775-01 |
J3590 |
|
J0223 |
Injection, givosiran, for subcutaneous use (Givlaari™) 0.5 mg |
71336-1001-01 |
J3490 |
|
Q5119 |
Injection, rituximab-pvvr, biosimilar, (Ruxience™) 10 mg |
00069-0238-01, 00069-0249-01 |
J9999 |
|
J9198 |
Injection, gemcitabine hydrochloride (Infugem™), 100 mg |
62756-0073-60, 62756-0008-60, 62756-0102-60, 62756-0219-60, 62756-0321-60, 62756-0438-60, 62756-0533-60, 62756-0614-60, 62756-0746-60, 62756-0974-60 |
J9199 |
|
J9246 |
Injection, melphalan (Evomela®), 1 mg |
68152-0109-00, 72893-0001-01 |
J9245 |
|
J1558 |
Injection, immune globulin subcutaneous, human – klhw 20% solution (Xembify®), 100 mg |
13533-0810-05, 13533-0810-06, 13533-0810-10, 13533-0810-11, 13533-0810-20, 13533-0810-21, 13533-0810-50, 13533-0810-51 |
J3590 |
|
J0791 |
Injection, crizanlizumab-tmca, for intravenous use (Adakveo®) 5 mg |
69171-0398-01 |
J3590 |
|
J0742 |
Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg (Recarbrio™) |
00006-3856-01, 00006-3856-02 |
J3490 |
|
J0691 |
Injection, lefamulin, for intravenous use (Xenleta™) |
72000-0120-01, 72000-0120-06 |
J3490 |
Contact
Medicaid Contact Center: 888-245-0179