2023 Part B MAC Update

2023 Part B MAC Update

Part B SNF CB – 2023 July Updates

CodeShort DescriptorEffective DateAction Needed
ADDITIONS   
J9196Inj gemcitabine hcl (accord)04-01-23Add to File #1
J9294Inj pemetrexed, hospira 10mg04-01-23Add to File #1
J9296Inj pemetrexed (accord) 10mg04-01-23Add to File #1
J9297Inj pemetrexed (sandoz) 10mg04-01-23Add to File #1
Q5129Inj, vegzelma, 10 mg04-01-23Add to File #1
C9146Inj, elahere, 1 mg04-01-23Add to File #1

This quarterly update includes revisions to the Part B SNF CB files to remove COVID-19 related vaccine, vaccine administration, monoclonal antibody treatment codes, and monoclonal antibody treatment administration codes from File #1 effective for claims after June 30, 2023. The deletions include codes that have been effectuated and reserved.
 

CodeShort DescriptorEffective DateAction Needed
DELETIONS   
0001A – 0309AAll effectuated and reserved COVID-19 vaccine administration CPT codes ending in “A”07/01/23Remove from File #1

91300 – 91317

91323 - 91325

All effectuated and reserved COVID-19 vaccine CPT codes within these ranges07/01/23Remove from File #1
M0201 – M0250All effectuated and reserved COVID-19 vaccine HCPCS codes within this range07/01/23Remove from File #1
Q0201 – Q0250All effectuated and reserved COVID-19 vaccine administration HCPCS codes within this range07/01/23Remove from File #1
Q2033INFLUENZA VACCINE, (FLUBOK)01/01/24Remove from File #1

Part B SNF CB – April 2023 Updates

CodeShort DescriptorEffective DateSourceAction Needed
Q5119Inj ruxience, 10 mgDOS on and after 7/1/20TDL 230004Add to File #1 – 2021 - 2023
91316SARSCOV2 VAC BVL 10MCG/0.2ML12/08/22TDL230125Add to File #1 - 2023
91317SARSCOV2 VAC BVL 3MCG/0.2ML12/08/22TDL 230125Add to File #1 - 2023
0164AADM SRSCV2 BVL 10MCG/0.2ML B12/08/22TDL 230125Add to File #1 - 2023
0173AADM SARSCV2 BVL 3MCG/0.2ML 312/08/22TDL 230125Add to File #1 - 2023
J7170INJ., EMICIZUMAB-KXWH 0.5 MG10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7175INJ, FACTOR X, (HUMAN), 1IU10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7179VONVENDI INJ 1 IU VWF:RCO10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7180FACTOR XIII ANTI-HEM FACTOR10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7181FACTOR XIII RECOMB A-SUBUNIT10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7182FACTOR VIII RECOMB NOVOEIGHT10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7183WILATE INJECTION10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7185XYNTHA INJ10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7186ANTIHEMOPHILIC VIII/VWF COMP10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7187HUMATE-P, INJ10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7188FACTOR VIII RECOMB OBIZUR10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7189FACTOR VIIA RECOMB NOVOSEVEN10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7190FACTOR VIII10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7191FACTOR VIII (PORCINE)10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7192FACTOR VIII RECOMBINANT NOS10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7193FACTOR IX NON-RECOMBINANT10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7194FACTOR IX COMPLEX10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7195FACTOR IX RECOMBINANT NOS10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7196ANTITHROMBIN RECOMBINANT10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7197ANTITHROMBIN III INJECTION10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7198ANTI-INHIBITOR10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7199HEMOPHILIA CLOT FACTOR NOC10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7200FACTOR IX RECOMBINAN RIXUBIS10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7201FACTOR IX ALPROLIX RECOMB10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7202FACTOR IX IDELVION INJ10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7203FACTOR IX RECOMB GLY REBINYN10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7204INJ.,FACTOR VIII, ANTIHEMOPHILIC FACTOR (RECOMBINANT), (ESPEROCT), GLYCOPEGYLATED-EXEI10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7205FACTOR VIII FC FUSION RECOMB10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7207FACTOR VIII PEGYLATED RECOMB10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7209FACTOR VIII NUWIQ RECOMB 1IU10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7210INJ, AFSTYLA, 1 I.U.10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7211INJ, KOVALTRY, 1 I.U.10/01/21TDL 10866Add to File #1 – 2021 - 2023
J7212FACTOR VIIA RECOMB SEVENFACT10/01/21TDL 10866Add to File #1 – 2021 - 2023
Q5123INJECTION, RITUXIMAB-ARRX, BIOSIMILAR, (RIABNI), 10 MG07/01/21TDL 10866Add to File #1 – 2021 - 2023
J0892   ARGATROBAN DIALYSIS (ACCORD)    01/9/23TDL 230150Add to File #1 for 2023
J0899   ARGATROBAN DIALYSIS, AUROMED     01/9/23TDL 230150Add to File #1 for 2023
M1187   PT W/ ESRD    01/01/23PolicyAdd to File #1 for 2023
J0893   INJ, DECITABINE (SUN PHARMA)01/01/23PolicyAdd to File #1 for 2023
J9046   INJ, BORTEZOMIB, DR. REDDY'S01/01/23PolicyAdd to File #1 for 2023
J9048   INJ, BORTEZOMIB FRESENIUSKAB            01/01/23PolicyAdd to File #1 for 2023
J9049   INJ, BORTEZOMIB, HOSPIRA       01/01/23PolicyAdd to File #1 for 2023
J9393   INJ, FULVESTRANT (TEVA)          01/01/23PolicyAdd to File #1 for 2023
J9394   INJ, FULVESTRANT (FRESENIUS)01/01/23PolicyAdd to File #1 for 2023
Q5126  INJ ALYMSYS 10 MG01/01/23PolicyAdd to File #1 for 2023
J0891   ARGATROBAN NONESRD (ACCORD)       01/01/23PolicyAdd to File #1 for 2023
J0898   ARGATROBAN NONESRD (AUROMED)   01/01/23PolicyAdd to File #1 for 2023
J0879   "INJECTION, DIFELIKEFALIN, 0.1 MICROGRAM, (FOR ESRD ON DIALYSIS)              04/01/22PolicyAdd to File #1 for 2022 and 2023
     
DELETIONS    
C9142 INJ, ALYMSYS, 10 MG    01/01/23PolicyDelete from File #1
J9044   INJ, BORTEZOMIB, NOS, 0.1 MG01/01/23PolicyDelete from File #1

 

 

 

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Page Last Modified:
12/18/2023 11:46 AM
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