2025 HCPCS Code Update - January Edition - Correct Coding

Joint DME MAC and PDAC Publication
Posted January 2, 2025

The following tables identify changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for January 2025. The tables contain only HCPCS codes applicable to items within Medicare DME MAC jurisdiction. There may be other HCPCS code changes for items under the jurisdiction of other Medicare contractors. Consult those contractors for information regarding HCPCS codes within their areas of responsibility.

All HCPCS code changes are effective for claims with dates of service on or after January 1, 2025.

Code Change Categories

  • Added Codes/Modifiers: Identifies newly created codes and modifiers. Listing of a code in the tables does not necessarily indicate coverage. Refer to the applicable Local Coverage Determination for information regarding Medicare reimbursement requirements.
  • Discontinued Codes/Deleted Modifiers: Identifies codes and modifiers discontinued or deleted in the new cycle. These codes and modifiers continue to be valid for Medicare claims with dates of service either on or before December 31, 2024. There is no grace period for submission of a discontinued code/modifier for claims with dates of service after its effective end date. If there is a direct crosswalk for a discontinued/deleted code or modifier, the crosswalk code will be displayed in a table.
  • Narrative Changes: Identifies changes in the narrative descriptor for an existing code or modifier.

Added Codes

Immunosuppressive Drugs

Code Narrative
J7514 MYCOPHENOLATE MOFETIL (MYHIBBIN), ORAL SUSPENSION, 100 MG

Intravenous Immune Globulin

Code Narrative
J1552 INJECTION, IMMUNE GLOBULIN (ALYGLO), 500 MG

Nebulizers

Code Narrative
J7601 ENSIFENTRINE, INHALATION SUSPENSION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 3 MG

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

Code Narrative
Q0155 DRONABINOL (SYNDROS), 0.1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN

Miscellaneous

Code Narrative
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
J0139 INJECTION, ADALIMUMAB, 1 MG
J0666 INJECTION, BUPIVACAINE LIPOSOME, 1 MG
J0870 INJECTION, IMETELSTAT, 1 MG
J1307 INJECTION, CROVALIMAB-AKKZ, 10 MG
J1414 INJECTION, FIDANACOGENE ELAPARVOVEC-DZKT, PER THERAPEUTIC DOSE
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
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

Discontinued Codes

Miscellaneous

Code Narrative
J0135 INJECTION, ADALIMUMAB, 20 MG
J0570 BUPRENORPHINE IMPLANT, 74.2 MG
J2796 INJECTION, ROMIPLOSTIM, 10 MICROGRAMS
J2806 INJECTION, SINCALIDE (MAIA), NOT THERAPEUTICALLY EQUIVALENT TO J2805, 5 MICROGRAMS
J9058 INJECTION, BENDAMUSTINE HYDROCHLORIDE (APOTEX), 1 MG
J9059 INJECTION, BENDAMUSTINE HYDROCHLORIDE (BAXTER), 1 MG
J9259 INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES (AMERICAN REGENT), NOT THERAPEUTICALLY EQUIVALENT TO J9264, 1 MG
Q0516 PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION ORAL DRUG, PER 30-DAYS
Q0519 PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION INJECTABLE DRUG, PER 30-DAYS
Q0520 PHARMACY SUPPLYING FEE FOR HIV PRE-EXPOSURE PROPHYLAXIS FDA APPROVED PRESCRIPTION INJECTABLE DRUG, PER 60-DAYS
Q5131 INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 20 MG
Q5132 INJECTION, ADALIMUMAB-AFZB (ABRILADA), BIOSIMILAR, 10 MG

Narrative Changes

Miscellaneous

Code Old Narrative New Narrative
E1800 DYNAMIC ADJUSTABLE ELBOW EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL DYNAMIC ADJUSTABLE ELBOW EXTENSION AND FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
E1805 DYNAMIC ADJUSTABLE WRIST EXTENSION / FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL DYNAMIC ADJUSTABLE WRIST EXTENSION AND FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
E1815 DYNAMIC ADJUSTABLE ANKLE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL DYNAMIC ADJUSTABLE ANKLE EXTENSION AND FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
E1825 DYNAMIC ADJUSTABLE FINGER EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL DYNAMIC ADJUSTABLE FINGER EXTENSION AND FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
E1830 DYNAMIC ADJUSTABLE TOE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL DYNAMIC ADJUSTABLE TOE EXTENSION AND FLEXION DEVICE, INCLUDES SOFT INTERFACE MATERIAL
J2468 INJECTION, PALONOSETRON HYDROCHLORIDE (AVYXA), NOT THERAPEUTICALLY EQUIVALENT TO J2469, 25 MICROGRAMS INJECTION, PALONOSETRON HYDROCHLORIDE (POSFREA), 25 MICROGRAMS
J9033 INJECTION, BENDAMUSTINE HCL (TREANDA), 1 MG INJECTION, BENDAMUSTINE HYDROCHLORIDE, 1 MG
J9072 INJECTION, CYCLOPHOSPHAMIDE (AVYXA), 5 MG INJECTION, CYCLOPHOSPHAMIDE (DR. REDDY'S), 5 MG
L8720 EXTERNAL LOWER EXTREMITY SENSORY PROSTHESIS, CUTANEOUS STIMULATION OF MECHANORECEPTORS PROXIMAL TO THE ANKLE, PER LEG EXTERNAL LOWER EXTREMITY SENSORY PROSTHETIC DEVICE, CUTANEOUS STIMULATION OF MECHANORECEPTORS PROXIMAL TO THE ANKLE, PER LEG

For questions about correct coding or products not listed on the DMECS Product Classification List (PCL), contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 a.m. to 5:00 p.m. ET, Monday through Friday. You may also visit the PDAC website to chat with a representative or select the Contact Us button at the top of the PDAC website for email, FAX, or postal mail information.

Revision History

Date of Change Description
01/02/25 Originally Published
Last Updated Jan 02 , 2025