OBR OncologyOncologists May Be Tripped Up by HCPCS Coding Changes

Navigating the New Terrain: HCPCS Coding Updates and Their Impact on Oncology Care

The Centers for Medicare and Medicaid Services (CMS) have rolled out significant updates to the Healthcare Common Procedure Coding System (HCPCS) as of January 1, 2024, introducing a range of new codes that are vital for oncologists to understand. These updates, which span across treatments for various cancers and navigation services, are crucial for ensuring maximum reimbursement and adherence to compliance standards. This summary explains the essential elements of the HCPCS changes, offering oncologists a clear guide to navigating these updates effectively.

Key Points:

• CMS has introduced new HCPCS codes for drugs targeting lung cancer, breast cancer, leukemia, and lymphoma, alongside principal illness navigation codes, effective from January 1, 2024.
• New injection codes have been added to combat adverse effects of cancer therapies, including C9145 for aprepitant, used to prevent chemotherapy-induced nausea and vomiting.
• The update includes new codes for eflapegrastim-xnst (J1449), pegfilgrastim-pbbk (Q5130), and pegfilgrastim-fpgk (Q5127) to treat neutropenia.
• Additional codes for pemetrexed injections have been added to address non-small cell lung cancer (NSCLC) treatment, with multiple variants based on the manufacturing source.
• J9347 is a new code for tremelimumab-actl, used in treating NSCLC without EGFR or ALK gene abnormalities.
• New leukemia treatment codes include J9255 for methotrexate and several codes for bendamustine injections, useful in certain lymphomas and leukemias.
• CMS emphasizes the importance of manual verification for drug waste reporting, advising against sole reliance on coding software.
• New HCPCS G-codes (G0023, G0024, G0140, G0146) have been introduced for principal illness navigation services, requiring an initial evaluation and management visit.
• The national nonfacility rates for the new G-codes are provided, with G0023 and G0140 priced at $79.24, and G0024 and G0146 at $49.44.

“We recommend that you do not rely on your coding software to determine if waste can be reported for a drug.”
– Angie Wood, CPC, from Pinnacle Enterprise Risk Consulting Services, emphasizing the necessity of manual verification for accurate billing

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