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Healthcare Common Procedure Coding System (HCPCS) code updates to specific drug contract service groupings

 

Individual service codes will be assigned within contract service groupings. Changes to an individual provider’s compensation will depend on the presence or absence of specific service groupings within the contract. The changes are outlined below.

 

All updates will start on March 1, 2020, unless otherwise noted.

 

 

Codes

Provider types affected

What’s changing

J1095, J2186, J2787

Facilities including acute short-term hospitals, free-standing ambulatory surgery centers, skilled nursing facilities

These codes will be added to the following contract service groupings:

  • All drugs or drug agents without specific rate set forth above or herein
  • Drugs
  • Chemotherapy and All Other Drugs
  • Chemotherapy & All Oth Drg
  • All Other Drugs

Q5109, Q5111

Facilities including acute short-term hospitals, free-standing ambulatory surgery centers, skilled nursing facilities, infusion facilities, dialysis facilities, physician providers, home health providers

 

These codes will be added to the following contract service groupings:

  • All drugs or drug agents without specific rate set forth above or herein
  • Drugs
  • Chemotherapy and All Other Drugs
  • Chemotherapy & All Oth Drg
  • All Other Drugs
  • All Drugs, agents, inj. Drugs
  • Injectable Drugs
  • All Outpatient Drugs including C, J, Q and S codes

J9022, J9023, J9203, J9285

Facilities including acute short-term hospitals, free-standing ambulatory surgery centers, skilled nursing facilities

These codes will be added to the following contract service groupings:

  • Drugs
  • Chemotherapy and All Other Drugs
  • Chemotherapy and All Oth Drg
  • Chemotherapy Drugs
  • All drugs or drug agents without specific rate set forth above or herein

J3591

Facilities including acute short-term hospitals, free-standing ambulatory surgery centers, skilled nursing facilities, infusion facilities, dialysis facilities, physician providers, home health providers

 

These codes will be added to the following contract service groupings:

  • Drugs
  • Chemotherapy and All Other Drugs
  • All Other Drugs
  • Chemotherapy & All Oth Drg
  • All drug or drug agents without specific rate set forth above or herein

 

J0185, J0517, J0567, J0584, J0599, J0841, J1301, J1454, J1628, J1746, J2062, J2797

J3245, J3304, J3397, J3398, J7170, J7177, J7203, J7318, J7329

Q9991, Q9992,

Q5105, Q5106, Q5108,

Q5110

Facilities including acute short-term hospitals, free-standing ambulatory surgery centers, skilled nursing facilities

These codes will be removed from the following contract service grouping:

  • Chemotherapy Drugs

 

This is subject to regulatory review and separate notification in Washington state.