December 3, 2024
January 2025 HCPCS Updates – New, Revised, and Discontinued HCPCS Codes and Modifiers
The following information is based on the January 2025 Healthcare Common Procedure Coding System (HCPCS) file. There are several updates that will be effective January 1, 2025. Please keep in mind that the appearance of a HCPCS code is not an indication of coverage by the DME MAC.
This following list contains added HCPCS codes that will be effective January 1, 2025.
HCPCS | DESCRIPTION |
---|---|
E1803 | Dynamic adjustable elbow extension only device, includes soft interface material |
E1804 | Dynamic adjustable elbow flexion only device, includes soft interface material |
E1807 | Dynamic adjustable wrist extension only device, includes soft interface material |
E1808 | Dynamic adjustable wrist flexion only device, includes soft interface material |
E1813 | Dynamic adjustable knee extension only device, includes soft interface material |
E1814 | Dynamic adjustable knee flexion only device, includes soft interface material |
E1822 | Dynamic adjustable ankle extension only device, includes soft interface material |
E1823 | Dynamic adjustable ankle flexion only device, includes soft interface material |
E1826 | Dynamic adjustable finger extension only device, includes soft interface material |
E1827 | Dynamic adjustable finger flexion only device, includes soft interface material |
E1828 | Dynamic adjustable toe extension only device, includes soft interface material |
E1829 | Dynamic adjustable toe flexion only device, includes soft interface material |
J0601 | Sevelamer carbonate (renvela or therapeutically equivalent), oral, 20 mg (for esrd on dialysis) |
J0602 | Sevelamer carbonate (renvela or therapeutically equivalent), oral, powder, 20 mg (for esrd on dialysis) |
J0603 | Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for esrd on dialysis) |
J0605 | Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis) |
J0607 | Lanthanum carbonate, oral, 5 mg (for esrd on dialysis) |
J0608 | Lanthanum carbonate, oral, powder, 5 mg, not therapeutically equivalent to j0607 (for esrd on dialysis) |
J0609 | Ferric citrate, oral, 3 mg ferric iron, (for esrd on dialysis) |
J0615 | Calcium acetate, oral, 23 mg (for esrd on dialysis) |
J0666 | Injection, bupivacaine liposome, 1 mg |
J0870 | Injection, imetelstat, 1 mg |
J0901 | Vadadustat, oral, 1 mg (for esrd on dialysis) |
J1307 | Injection, crovalimab-akkz, 10 mg |
J1414 | Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose |
J1552 | Injection, immune globulin (alyglo), 500 mg |
J2290 | Injection, nafcillin sodium, 20 mg |
J2472 | Injection, pantoprazole sodium in sodium chloride (baxter), 40 mg |
J2802 | Injection, romiplostim, 1 microgram |
J3392 | Injection, exagamglogene autotemcel, per treatment |
J7514 | Mycophenolate mofetil (myhibbin), oral suspension, 100 mg |
J7601 | Ensifentrine, inhalation suspension, fda approved final product, non-compounded, administered through dme, unit dose form, 3 mg |
J9026 | Injection, tarlatamab-dlle, 1 mg |
J9028 | Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram |
J9076 | Injection, cyclophosphamide (baxter), 5 mg |
J9292 | Injection, pemetrexed (avyxa), not therapeutically equivalent to j9305, 10 mg |
Q0521 | Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription |
Q5139 | Injection, eculizumab-aeeb (bkemv), biosimilar, 10 mg |
Q5140 | Injection, adalimumab-fkjp, biosimilar, 1 mg |
Q5141 | Injection, adalimumab-aaty, biosimilar, 1 mg |
Q5142 | Injection, adalimumab-ryvk biosimilar, 1 mg |
Q5143 | Injection, adalimumab-adbm, biosimilar, 1 mg |
Q5144 | Injection, adalimumab-aacf (idacio), biosimilar, 1 mg |
Q5145 | Injection, adalimumab-afzb (abrilada), biosimilar, 1 mg |
Q5146 | Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg |
Q9996 | Injection, ustekinumab-ttwe (pyzchiva), subcutaneous, 1 mg |
Q9997 | Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg |
Q9998 | Injection, ustekinumab-aekn (selarsdi), 1 mg |
The following Modifier and HCPCS codes have description/verbiage changes that will be effective January 1, 2025.
HCPCS | DESCRIPTION |
---|---|
TB | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes |
E1800 | Dynamic adjustable elbow extension and flexion device, includes soft interface material |
E1805 | Dynamic adjustable wrist extension and flexion device, includes soft interface material |
E1810 | Dynamic adjustable knee extension and flexion device, includes soft interface material |
E1815 | Dynamic adjustable ankle extension and flexion device, includes soft interface material |
E1825 | Dynamic adjustable finger extension and flexion device, includes soft interface material |
E1830 | Dynamic adjustable toe extension and flexion device, includes soft interface material |
J2468 | Injection, palonosetron hydrochloride (posfrea), 25 micrograms |
J9033 | Injection, bendamustine hydrochloride, 1 mg |
J9072 | Injection, cyclophosphamide (avyxa), 5 mg |
L8720 | External lower extremity sensory prosthetic device, cutaneous stimulation of mechanoreceptors proximal to the ankle, per leg |
The following listing contains discontinued Modifier and HCPCS codes, along with the cross-walked HCPCS codes (if applicable). Please note, not all discontinued HCPCS codes will have a cross-walked HCPCS code.
HCPCS | DISCONTINUE DATE | CROSSWALK HCPCS CODE |
---|---|---|
JG | 12/31/2024 | |
J0135 | 12/31/2024 | |
J0570 | 12/31/2024 | |
J2796 | 12/31/2024 | |
J2806 | 12/31/2024 | |
J9058 | 12/31/2024 | |
J9059 | 12/31/2024 | |
J9259 | 12/31/2024 | |
Q0516 | 12/31/2024 | |
Q0517 | 12/31/2024 | |
Q0518 | 12/31/2024 | |
Q0519 | 12/31/2024 | |
Q0520 | 12/31/2024 | |
Q5131 | 12/31/2024 | |
Q5132 | 12/31/2024 |