Modifier and HCPCS Changes for July 2025 - JF Part B
Modifier and HCPCS Changes for July 2025
The following new and deleted National Level II modifiers and Healthcare Common Procedure Coding System (HCPCS) are effective for dates of service on/after July 1, 2025.
In compliance with the Health Insurance Portability and Accountability Act (HIPAA), CMS eliminated the 3-month grace period for discontinued codes in Change Request (CR) 3093 dated February 6, 2004. Effective for dates of services on/after January 1, 2010, there is no grace period for billing discontinued HCPCS codes.
Note: The inclusion of modifiers or codes on this web page do not necessarily indicate coverage. New modifiers and HCPCS identified as Durable Medical Equipment (DME) are not included in this listing.
New Modifiers
There are no new modifiers being implemented.
New Codes
| HCPCS | DESCRIPTION |
|---|---|
| C9174 | Injection, datopotamab deruxtecan-dlnk, 1 mg |
| C9175 | Injection, treosulfan, 50 mg |
| J0165 | Injection, epinephrine, not otherwise specified, 0.1 mg |
| J0166 | Injection, epinephrine (bpi), not therapeutically equivalent to j0165, 0.1 mg |
| J0167 | Injection, epinephrine (hospira), not therapeutically equivalent to j0165, 0.1 mg |
| J0168 | Injection, epinephrine (international medication systems), not therapeutically equivalent to j0165, 0.1 mg |
| J0169 | Injection, epinephrine (adrenalin), not therapeutically equivalent to j0165, 0.1 mg |
| J0616 | Injection, metoprolol tartrate, 1 mg |
| J0618 | Injection, calcium chloride, 2 mg |
| J1163 | Injection, diltiazem hydrochloride, 0.5 mg |
| J1326 | Injection, zolbetuximab-clzb, 2 mg |
| J2312 | Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg |
| J2313 | Injection, naloxone hydrochloride (zimhi), 0.01 mg |
| J3373 | Injection, vancomycin hydrochloride, 10 mg |
| J3374 | Injection, vancomycin hydrochloride (mylan) not therapeutically equivalent to j3373, 10 mg |
| J3375 | Injection, vancomycin hydrochloride (xellia), not therapeutically equivalent to j3373, 10 mg |
| J3391 | Injection, atidarsagene autotemcel, per treatment |
| J7172 | Injection, marstacimab-hncq, 0.5 mg |
| J7356 | Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg |
| J9174 | Injection, docetaxel (beizray), 1 mg |
| J9220 | Injection, indigotindisulfonate sodium, 1 mg |
| J9275 | Injection, cosibelimab-ipdl, 2 mg |
| J9276 | Injection, zanidatamab-hrii, 2 mg |
| J9289 | Injection, nivolumab, 2 mg and hyaluronidase-nvhy |
| J9341 | Injection, thiotepa (tepylute), 1 mg |
| J9342 | Injection, thiotepa, not otherwise specified, 1 mg |
| J9382 | Injection, zenocutuzumab-zbco, 1 mg |
| Q2058 | Obecabtagene autoleucel, 10 up to 400 million cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion |
| Q4368 | Amchothick, per square centimeter |
| Q4369 | Amnioplast 3, per square centimeter |
| Q4370 | Aeroguard, per square centimeter |
| Q4371 | Neoguard, per square centimeter |
| Q4372 | Amchoplast excel, per square centimeter |
| Q4373 | Membrane wrap lite, per square centimeter |
| Q4375 | Duograft ac, per square centimeter |
| Q4376 | Duograft aa, per square centimeter |
| Q4377 | Trigraft ft, per square centimeter |
| Q4378 | Renew ft matrix, per square centimeter |
| Q4379 | Amniodefend ft matrix, per square centimeter |
| Q4380 | Advograft one, per square centimeter |
| Q4382 | Advograft dual, per square centimeter |
| Q5098 | Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg |
| Q5099 | Injection, ustekinumab-stba (steqeyma), biosimilar, 1 mg |
| Q5100 | Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg |
| Q5153 | Injection, aflibercept-yszy (opuviz), biosimilar, 1 mg |
| 0552U | Reproductive medicine (preimplantation genetic assessment), analysis for known genetic disorders from trophectoderm biopsy, linkage analysis of disease-causing locus, and when possible, targeted mutation analysis for known familial variant, reported as low-risk or high-risk for familial genetic disorder |
| 0553U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using dna genomic sequence analysis from embryonic trophectoderm for structural rearrangements, aneuploidy, and a mitochondrial dna score, results reported as normal/balanced (euploidy/balanced), unbalanced structural rearrangement, monosomy, trisomy, segmental aneuploidy, or mosaic, per embryo tested |
| 0554U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using dna genomic sequence analysis from trophectoderm biopsy for aneuploidy, ploidy, a mitochondrial dna score, and embryo quality control, results reported as normal (euploidy), monosomy, trisomy, segmental aneuploidy, triploid, haploid, or mosaic, with quality control results reported as contamination detected or inconsistent cohort when applicable, per embryo tested |
| 0555U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using dna genomic sequence analysis from embryonic trophectoderm for structural rearrangements, aneuploidy, ploidy, a mitochondrial dna score, and embryo quality control, results reported as normal/balanced (euploidy/balanced), unbalanced structural rearrangement, monosomy, trisomy, segmental aneuploidy, triploid, haploid, or mosaic, with quality control results reported as contamination detected or inconsistent cohort when applicable, per embryo tested |
| 0556U | Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific dna and rna by real-time pcr, 12 targets, nasopharyngeal or oropharyngeal swab, including multiplex reverse transcription for rna targets, each analyte reported as detected or not detected |
| 0557U | Infectious disease (bacterial vaginosis and vaginitis), real-time amplification of dna markers for atopobium vaginae, gardnerella vaginalis, megasphaera types 1 and 2, bacterial vaginosis associated bacteria-2 and -3 (bvab-2, bvab-3), mobiluncus species, trichomonas vaginalis, neisseria gonorrhoeae, candida species (c. albicans, c. tropicalis, c. parapsilosis, c. glabrata, c. krusei), herpes simplex viruses 1 and 2, vaginal fluid, reported as detected or not detected for each organism |
| 0558U | Oncology (colorectal), quantitative enzyme-linked immunosorbent assay (elisa) for secreted colorectal cancer protein marker (bf7 antigen), using serum, result reported as indicative of response/no response to therapy or disease progression/regression |
| 0559U | Oncology (breast), quantitative enzyme-linked immunosorbent assay (elisa) for secreted breast cancer protein marker (bf9 antigen), serum, result reported as indicative of response/no response to therapy or disease progression/regression |
| 0560U | Oncology (minimal residual disease [mrd]), genomic sequence analysis, cell-free dna, whole blood and tumor tissue, baseline assessment for design and construction of a personalized variant panel to evaluate current mrd and for comparison to subsequent mrd assessments |
| 0561U | Oncology (minimal residual disease [mrd]), genomic sequence analysis, cell-free dna, whole blood, subsequent assessment with comparison to initial assessment to evaluate for mrd |
| 0562U | Oncology (solid tumor), targeted genomic sequence analysis, 33 genes, detection of single-nucleotide variants (snvs), insertions and deletions, copy-number amplifications, and translocations in human genomic circulating cell-free dna, plasma, reported as presence of actionable variants |
| 0563U | Infectious disease (bacterial and/or viral respiratory tract infection), pathogen-specific nucleic acid (dna or rna), 11 viral targets and 4 bacterial targets, qualitative rt-pcr, upper respiratory specimen, each pathogen reported as positive or negative |
| 0564U | Infectious disease (bacterial and/or viral respiratory tract infection), pathogen-specific nucleic acid (dna or rna), 10 viral targets and 4 bacterial targets, qualitative rt-pcr, upper respiratory specimen, each pathogen reported as positive or negative |
| 0565U | Oncology (hepatocellular carcinoma), next-generation sequencing methylation pattern assay to detect 6626 epigenetic alterations, cell-free dna, plasma, algorithm reported as cancer signal detected or not detected |
| 0566U | Oncology (lung), qpcr-based analysis of 13 differentially methylated regions (ccdc181, hoxa7, lrrc8a, marchf11, mir129-2, ncor2, pantr1, prkcb, slc9a3, tbr1_2, trap1, vwc2, znf781), pleural fluid, algorithm reported as a qualitative result |
| 0567U | Rare diseases (constitutional/heritable disorders), whole-genome sequence analysis combination of short and long reads, for single-nucleotide variants, insertions/deletions and characterized intronic variants, copy-number variants, duplications/deletions, mobile element insertions, runs of homozygosity, aneuploidy, and inversions, mitochondrial dna sequence and deletions, short tandem repeat genes, methylation status of selected regions, blood, saliva, amniocentesis, chorionic villus sample or tissue, identification and categorization of genetic variants |
| 0568U | Neurology (dementia), beta amyloid (ab40, ab42, ab42/40 ratio), tau-protein phosphorylated at residue (eg, ptau217), neurofilament light chain (nfl), and glial fibrillary acidic protein (gfap), by ultra-high sensitivity molecule array detection, plasma, algorithm reported as positive, intermediate, or negative for alzheimer pathology |
| 0569U | Oncology (solid tumor), next-generation sequencing analysis of tumor methylation markers (>20000 differentially methylated regions) present in cell-free circulating tumor dna (ctdna), whole blood, algorithm reported as presence or absence of ctdna with tumor fraction, if appropriate |
| 0570U | Neurology (traumatic brain injury), analysis of glial fibrillary acidic protein (gfap) and ubiquitin carboxyl-terminal hydrolase l1 (uch-l1), immunoassay, whole blood or plasma, individual components reported with the overall result of elevated or non-elevated based on threshold comparison |
| 0571U | Oncology (solid tumor), dna (80 genes) and rna (10 genes), by next-generation sequencing, plasma, including single-nucleotide variants, insertions/deletions, copy-number alterations, microsatellite instability, and fusions, reported as clinically actionable variants |
| 0572U | Oncology (prostate), high-throughput telomere length quantification by fish, whole blood, diagnostic algorithm reported as risk of prostate cancer |
| 0573U | Oncology (pancreas), 3 biomarkers (glucose, carcinoembryonic antigen, and gastricsin), pancreatic cyst lesion fluid, algorithm reported as categorical mucinous or non-mucinous |
| 0574U | Mycobacterium tuberculosis, culture filtrate protein?10-kda (cfp-10), serum or plasma, liquid chromatography mass spectrometry (lc-ms) |
| 90382 | Respiratory syncytial virus, monoclonal antibody, seasonal dose, 0.7 ml, for intramuscular use |
| 90612 | Influenza virus vaccine, trivalent, and severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) vaccine, mrna-lnp, 31.7 mcg/0.32 ml dosage, for intramuscular use |
| 90613 | Influenza virus vaccine, quadrivalent, and severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) vaccine, mrna-lnp, 40 mcg/0.4 ml dosage, for intramuscular use |
| 90635 | Influenza virus vaccine, h5n1, derived from cell cultures, adjuvanted, for intramuscular use |
| 91323 | Severe acute respiratory syndrome coronavirus 2 (sars-cov2)(coronavirus disease [covid-19]) vaccine, mrna-lnp, 10 mcg/0.2 ml dosage, for intramuscular use |
| 0948T | Remote evaluation of cardiac contractility modulation system, with analysis, review and report(s) by a physician or other qualified healthcare professional |
| 0949T | Remote evaluation of cardiac contractility modulation system, with data acquisition(s), receipt of transmissions, technician review, technical support, and distribution of results |
| 0950T | Destruction of benign prostate tissue using high intensity-focused ultrasound (HIFU) |
| 0951T | Initial placement of totally implantable active middle hearing implant |
| 0952T | Revision or replacement of totally implantable active middle hearing implant with mastoidectomy and replacement of sound processor |
| 0953T | Revision or replacement of totally implantable active middle hearing implant, without mastoidectomy and replacement of sound processor |
| 0954T | Replacement of totally implantable active middle hearing implant, sound processor only |
| 0955T | Removal of totally implantable active middle hearing implant |
| 0956T | Partial removal of skull for placement of continuous bilateral electroencephalography monitoring system |
| 0957T | Revision of sub-scalp implanted electrode array, receiver, and telemetry unit for electrode for a continuous bilateral electroencephalography system |
| 0958T | Removal of sub-scalp implanted electrode array, receiver, and telemetry unit for electrode for a continuous bilateral electroencephalography system |
| 0959T | Removal or replacement of magnet from coil assembly connected to continuous bilateral electroencephalography system |
| 0960T | Replacement of sub-scalp implanted electrode array, receiver, and telemetry unit with tunneling of electrode for continuous bilateral electroencephalography monitoring system |
| 0961T | Shortwave infrared radiation imaging to assist in finding lymph nodes is connective tissue surgical pathology specimen |
| 0962T | Assistive algorithmic analysis of acoustic and electrocardiogram recording for detection of cardiac dysfunction |
| 0963T | Anoscopy injection of bulking agent into anal canal |
| 0964T | Impression and custom preparation of jaw expansion oral prosthesis for obstructive sleep apnea, including initial adjustment; single arch, without mandibular advancement mechanism |
| 0965T | Impression and custom preparation of jaw expansion oral prosthesis for obstructive sleep apnea, including initial adjustment; dual arch, with additional mandibular advancement, non-fixed hinge mechanism |
| 0966T | Impression and custom preparation of jaw expansion oral prosthesis for obstructive sleep apnea, including initial adjustment; dual arch, with additional mandibular advancement, fixed hinge mechanism |
| 0967T | Insertion of endoluminal temporary colorectal anastomosis protection device, including vacuum anchoring component and flexible sheath connected to external vacuum source and monitoring system |
| 0968T | Insertion or replacement of epicranial neurostimulator system, including electrode array and pulse generator, with connection to electrode array |
| 0969T | Removal of epicranial neurostimulator system |
| 0970T | Destruction of benign breast tumor using laser |
| 0971T | Destruction of malignant breast tumor(s) using laser |
| 0972T | Assistive algorithmic classification of burn healing by noninvasive multispectral imaging, including system set-up and acquisition, selection, and transmission of images, with automated generation of report |
| 0973T | Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia, including patient monitoring, trunk, arms, legs, first 100 sq cm |
| 0974T | Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia, including patient monitoring, trunk, arms, legs, each additional 100 sq cm |
| 0975T | Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia, including patient monitoring, scalp, neck, hands, feet, and/or multiple digits, first 100 sq cm |
| 0976T | Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia, including patient monitoring, scalp, neck, hands, feet, and/or multiple digits, each additional 100 sq cm |
| 0977T | Detection of upper gastrointestinal blood with sensor capsule, with interpretation and report |
| 0978T | Submucosal cryolysis therapy, soft palate, base of tongue, and lingual tonsil |
| 0979T | Submucosal cryolysis therapy, soft palate only |
| 0980T | Submucosal cryolysis therapy, base of tongue and lingual tonsil only |
| 0981T | Implantation of wireless inferior vena cava sensor for long-term blood circulation monitoring |
| 0982T | Initial set-up and patient education on use of equipment for remote monitoring of implantable inferior vena cava pressure sensor |
| 0983T | Remote monitoring of an implanted inferior vena cava sensor for up to 30 days with at least weekly downloads of inferior vena cava area recordings, interpretation(s), trend analysis, and report(s) by a physician or other qualified health care professional |
| 0984T | Intravascular imaging of initial extracranial cerebral vessel using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report |
| 0985T | Intravascular imaging of each additional extracranial cerebral vessel using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report |
| 0986T | Intravascular imaging of initial intracranial cerebral vessels using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report |
| 0987T | Intravascular imaging of each additional intracranial cerebral vessels using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report |
Deleted Codes
| HCPCS | DESCRIPTION |
|---|---|
| C9173 | Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram |
| C9300 | Injection, indigotindisulfonate sodium, 1 mg |
| C9301 | Obecabtagene autoleucel, up to 400 million cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| C9302 | Injection, zanidatamab-hrii, 2 mg |
| C9303 | Injection, zolbetuximab-clzb, 1 mg |
| C9304 | Injection, marstacimab-hncq, 0.5 mg |
| G9037 | Interprofessional telephone/internet/electronic health record clinical question/request for specialty recommendations by a treating/requesting physician or other qualified health care professional for the care of the patient (i.e. not for professional education or scheduling) and may include subsequent follow up on the specialist's recommendations; 30 minutes |
| G9038 | Co-management services with the following elements: new diagnosis or acute exacerbation and stabilization of existing condition; condition which may benefit from joint care planning; condition for which specialist is taking a co-management role; condition expected to last at least 3 months; comprehensive care plan established, implemented, revised or monitored in partnership with co-managing clinicians; ongoing communication and care coordination between co-managing clinicians furnishing care |
| J0171 | Injection, adrenalin, epinephrine, 0.1 mg |
| J0173 | Injection, epinephrine (belcher), not therapeutically equivalent to j0171, 0.1 mg |
| J2310 | Injection, naloxone hydrochloride, per 1 mg |
| J2311 | Injection, naloxone hydrochloride (zimhi), 1 mg |
| J3370 | Injection, vancomycin hcl, 500 mg |
| J3371 | Injection, vancomycin hcl (mylan), not therapeutically equivalent to j3370, 500 mg |
| J3372 | Injection, vancomycin hcl (xellia), not therapeutically equivalent to j3370, 500 mg |
| J9340 | Injection, thiotepa, 15 mg |
| M0248 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency |
| 0240U | Respiratory infectious agent detection by RNA for severe acute respiratory syndrome coronavirus 2 (COVID-19), influenza A, and influenza B) in upper respiratory specimen, each reported as detected or not detected |
| 0241U | Respiratory infectious agent detection by RNA for severe acute respiratory syndrome coronavirus 2 (COVID 19), influenza A, influenza B, and respiratory syncytial virus, upper respiratory specimen, each reported as detected or not detected |
| 0369U | Test for 31 stomach and intestinal pathogens and identification of 21 antibiotic resistant genes |
| 0370U | Test for 34 surgical wound microorganisms and identification of 21 antibiotic resistant genes |
| 0373U | Test for 17 bacteria, 8 fungus, 13 virus, and 16 antibiotic-resistance genes associated with respiratory infection |
| 0374U | Test for 21 bacterial and fungal genitourinary pathogens and identification of 21 associated antibiotic-resistance genes |
Source
Transmittal 13116, CR 13968 dated March 13, 2025
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