Billing and Coding: Billing Limitations for Pharmacies (A56119) - R10 - Effective January 1, 2025

Date Posted: April 24, 2025

This coverage article has been revised and published for notice under contract numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Effective Date: January 1, 2025

Summary of Article Changes:

Under Article Guidance section, updated the Influenza Vaccine codes to remove the following codes:

  • 90654: end-dated 12/31/2024
  • 90659: end-dated 12/31/2003
  • 90663: end-dated 12/31/2011
  • 90665: end-dated 12/31/2012

Under Article Guidance section, updated the Hemophilia Clotting Factors codes to remove the following codes:

  • J7184: end-dated 12/31/2011
  • J7206: not a valid code and was incorrectly listed in the code range.

Under CPT/HCPCS Codes, added the following codes which were missing from the table section and were only previously listed in the Article Guidance section: 90653, 90683, J7203, J7204, J7207, J7208, J7209, J7210, J7211.

Visit the Noridian Billing and Coding Articles webpage to view the complete listing of coverage articles and/or access the Active, Future, or Retired articles available in the CMS MCD.

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