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Granted Codes

Effective for dates of service on or after January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) has granted the following Healthcare Common Procedure Coding System (HCPCS) codes for  the Medicare Outpatient Prospective Payment System (OPPS):

•MYLOTARG J-Code: J9203 – injection, gemtuzumab ozogamicin, 0.1 mg

The J-code will be able to be reported for both the physician office and outpatient hospital settings, and for both Medicare and non-Medicare payers. In addition, CMS has granted transitional pass-through status for MYLOTARG for the Medicare outpatient hospital setting (OPPS), which is also effective January 1, 2018.  Having pass-through status ensures that MYLOTARG will be paid at ASP+6% (subject to sequestration) under the OPPS for the next 2-3 years. The existing J-code for Mylotarg (J9300) will be deleted at the end of this year.

•BESPONSA C-Code: C9028 – injection, inotuzumab ozogamicin, 0.1 mg

This temporary C-code is specific to inotuzumab and is only for use on Medicare hospital outpatient claims; C-codes cannot be used in the physician office setting.  Additionally, private commercial payers and state Medicaid programs have the discretion to accept C-codes but are not required to use them. Reimbursement for covered Medicare OPPS claims will be based on the ASP+6% payment methodology effective, January 1, 2018 (subject to sequestration).  Medicare Part B claims in the physician office setting of care will continue to be submitted with “Not Otherwise Classified” (NOC) HCPCS codes for 2018 (until the J-code is issued for 2019).   NOC codes also will need to be used for any non-Medicare payers that do not accept C-codes.

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