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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  

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