Modifier and HCPCS Changes for October 2025 - JE Part B
Modifier and HCPCS Changes for October 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 October 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 |
|---|---|
| A2036 | Cohealyx collagen dermal matrix, per square centimeter |
| A2037 | G4derm plus, per milliliter |
| A2038 | Marigen pacto, per square centimeter |
| A2039 | Innovamatrix fd, per square centimeter |
| A9612 | Injection, fluorescein, 1 mg |
| A9616 | Gallium ga-68 gozetotide (gozellix), diagnostic, 1 millicurie |
| C1740 | Leadless electrode, transmitter, battery (all implantable), for sequential left ventricular pacing |
| C1741 | Anchor/screw for bone fixation, absorbable (implantable) |
| C1742 | Pressure monitoring system, compartmental intramuscular (implantable), continuous, including all components (e.g., introducer, sensor), excludes mobile (wireless) software application |
| C8006 | Insertion of pleural-peritoneal shunt with intercostal pump chamber, including imaging, injection(s) of contrast with radiological supervision and interpretation, when performed |
| C9305 | Injection, nipocalimab-aahu, 3 mg |
| C9306 | Injection, telisotuzumab vedotin-tllv, 1 mg |
| J0163 | Injection, epinephrine in sodium chloride (endo), 0.1 mg |
| J0164 | Injection, epinephrine in sodium chloride (baxter), 0.1 mg |
| J0458 | Injection, aztreonam/avibactam, 7.5 mg/2.5 mg (10 mg) |
| J0462 | Injection, atropine sulfate, not therapeutically equivalent to j0461, 0.01 mg |
| J0525 | Injection, cefotetan disodium, 10 mg |
| J0570 | Buprenorphine implant, 74.2 mg |
| J0582 | Injection, bivalirudin (endo), not therapeutically equivalent to j0583, 1 mg |
| J0614 | Injection, treosulfan, 50 mg |
| J0668 | Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg |
| J0675 | Injection, carboprost tromethamine, 0.1 mg |
| J0681 | Injection, ceftobiprole medocaril sodium, 3 mg |
| J0738 | Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv) |
| J0752 | Oral, lenacapavir, 300 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv) |
| J0759 | Injection, clevidipine butyrate, 1 mg |
| J1370 | Injection, esomeprazole sodium, 1 mg |
| J1612 | Injection, glucagon (gvoke), 0.01 mg |
| J1807 | Injection, ethacrynate sodium, 1 mg |
| J1809 | Injection, fosdenopterin, 0.1 mg |
| J1834 | Injection, isoniazid, 1 mg |
| J2151 | Injection, mannitol, 250 mg |
| J2291 | Injection, nafcillin sodium (baxter), 20 mg |
| J3290 | Injection, tranexamic acid, 5 mg |
| J3402 | Injection, remestemcel-l-rknd, per therapeutic dose |
| J3403 | Revakinagene taroretcel-lwey, per implant |
| J7173 | Injection, concizumab-mtci, 0.5 mg |
| J7174 | Injection, fitusiran, 0.04 mg |
| J9011 | Injection, datopotamab deruxtecan-dlnk, 1 mg |
| M0235 | Intravenous infusion, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, not otherwise classified, first dose |
| M0236 | Intravenous infusion, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, not otherwise classified, second dose |
| M0237 | Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose |
| M0238 | Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose |
| Q0235 | Injection, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, not otherwise classified, 1 mg |
| Q0237 | Injection, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg |
| Q4383 | Axolotl graft ultra, per square centimeter |
| Q4384 | Axolotl dualgraft ultra, per square centimeter |
| Q4385 | Apollo ft, per square centimeter |
| Q4386 | Acesso trifaca, per square centimeter |
| Q4387 | Neothelium ft, per square centimeter |
| Q4388 | Neothelium 4l, per square centimeter |
| Q4389 | Neothelium 4l+, per square centimeter |
| Q4390 | Ascendion, per square centimeter |
| Q4391 | Amnioplast double, per square centimeter |
| Q4392 | Grafix duo, per square centimeter |
| Q4393 | Surgraft ac, per square centimeter |
| Q4394 | Surgraft aca, per square centimeter |
| Q4395 | Acelagraft, per square centimeter |
| Q4396 | Natalin, per square centimeter |
| Q4397 | Summit aaa, per square centimeter |
| Q5154 | Injection, omalizumab-igec (omlyclo), biosimilar, 5 mg |
| Q5155 | Injection, aflibercept-jbvf (yesafili), biosimilar, 1 mg |
| Q5156 | Injection, tocilizumab-anoh (avtozma), biosimilar, 1 mg |
| Q5157 | Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mg |
| Q5157 | Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mg |
| Q5158 | Injection, denosumab-bnht (bomyntra/conexxence), biosimilar, 1 mg |
| Q5158 | Injection, denosumab-bnht (bomyntra/conexxence), biosimilar, 1 mg |
| Q5159 | Injection, denosumab-dssb (ospomyv/xbryk), biosimilar, 1 mg |
| 0575U | Transplantation medicine (liver allograft rejection), mirna gene expression profiling by rt-pcr of 4 genes (mir-122, mir-885, mir-23a housekeeping, spike-in control), serum, algorithm reported as risk of liver allograft rejection |
| 0576U | Transplantation medicine (liver allograft rejection), quantitative donor-derived cell-free dna (cfdna) by whole genome nextgeneration sequencing, plasma and mrna gene expression profiling by multiplex real-time pcr of 56 genes, whole blood, combined algorithm reported as a rejection risk score |
| 0577U | Oncology (ovarian), serum, analysis of 39 glycoproteins by liquid chromatography with tandem mass spectrometry (lc-ms/ms) in multiple reaction monitoring mode, reported as likelihood of malignancy |
| 0578U | Oncology (cutaneous melanoma), rna, gene expression profiling by realtime qpcr of 10 genes (8 content and 2 housekeeping), utilizing formalin-fixed paraffin-embedded (ffpe) tissue, algorithm reports a binary result, either low-risk or high-risk for sentinel lymph node metastasis and recurrence |
| 0579U | Nephrology (diabetic chronic kidney disease), enzymelinked immunosorbent assay (elisa) of apolipoprotein a4 (apoa4), cd5 antigen-like (cd5l) combined with estimated glomerular filtration rate (gfr), age, plasma, algorithm reported as a risk score for kidney function decline |
| 0580U | Borrelia burgdorferi, antibody detection of 24 recombinant protein groups, by immunoassay, igg |
| 0581U | Transplantation medicine, antibody to non-human leukocyte antigens (nonhla), blood specimen, flow cytometry, single-antigen bead technology, 39 targets, individual positive antibodies reported |
| 0582U | Rare diseases (constitutional disease/hereditary disorders), rapid whole genome dna sequencing for singlenucleotide variants, insertions/deletions, copy number variations, blood, saliva, tissue sample, variants reported |
| 0583U | Rare diseases (constitutional disease/hereditary disorders), rapid whole genome comparator dna sequencing for single-nucleotide variants, insertions/deletions, copy number variations, blood, saliva, tissue sample, variants reported with proband results (list separately in addition to code for primary procedure) |
| 0584U | Neurology (prion disease), cerebrospinal fluid, detection of prion protein by quakinginduced conformational conversion, qualitative |
| 0585U | Targeted genomic sequence analysis panel, solid organ neoplasm, circulating cell-free dna (cfdna) analysis from plasma of 521 genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, and microsatellite instability, report shows identified mutations, including variants with clinical actionability |
| 0586U | Oncology, mrna, gene expression profiling of 216 genes (204 targeted and 12 housekeeping genes), rna expression analysis, formalinfixed paraffin-embedded (ffpe) tissue, quantitative, reported as log2 ratio per gene |
| 0587U | Therapeutic drug monitoring, 60-150 drugs and metabolites, urine, saliva, quantitative liquid chromatography with tandem mass spectrometry (lcms/ms), specimen validity, and algorithmic analyses for presence or absence of drug or metabolite, risk score predicted for adverse drug effects |
| 0588U | Infectious disease (bacterial or viral), 32 genes (29 informative and 3 housekeeping), immune response mrna, gene expression profiling by splitwell multiplex reverse transcription loop-mediated isothermal amplification (rtlamp), whole blood, reported as continuous risk scores for likelihood of bacterial and viral infection and likelihood of severe illness within the next 7 days |
| 0589U | Perfluoroalkyl substances (pfas) (eg, perfluorooctanoic acid, perfluorooctane sulfonic acid), 24 pfas compounds by high-performance liquid chromatography with tandem mass spectrometry (lcms/ms), plasma or serum, quantitative |
| 0590U | Infectious disease (bacterial and fungal), dna of 44 organisms (34 bacteria, 10 fungi), urine, next-generation sequencing, reported as positive or negative for each organism |
| 0591U | Oncology (prostate cancer), biochemical analysis of 3 proteins (total psa, free psa, and he4), plasma, serum, prognostic algorithm incorporating 3 proteins and digital rectal examination, results reported as a probability score for clinically significant prostate cancer |
| 0592U | Oncology (hematolymphoid neoplasms), dna, targeted genomic sequence of 417 genes, interrogation for gene fusions, translocations, rearrangements, utilizing formalin-fixed paraffinembedded (ffpe) tumor tissue, results report clinically significant variant(s) |
| 0593U | Infectious disease (genitourinary pathogens), dna, 46 targets (28 pathogens, 18 resistance genes), rt-pcr amplified probe technique, urine, each analyte reported as detected or not detected |
| 0594U | Infectious disease (sepsis), semiquantitative measurement of pancreatic stone protein concentration, whole blood, reported as risk of sepsis |
| 0595U | Infectious disease (tropical fever pathogens), vectorborne and zoonotic pathogens, including 2 viruses (chikungunya virus and dengue virus serotypes 1, 2, 3, and 4), 1 bacterium (leptospira species), and 1 parasite with species differentiation (plasmodium species, plasmodium falciparum, and plasmodium vivax/ovale), real-time rtpcr, whole blood, each pathogen reported as detected or not detected |
| 0596U | Neurology (alzheimer disease), plasma, 3 distinct isoform-specific peptides (apoe2, apoe3, and apoe4) by liquid chromatography with tandem mass spectrometry (lcms/ms), reported as an apoe prototype |
| 0597U | Oncology (breast), rna expression profiling of 329 genes by targeted nextgeneration sequencing and 20 proteins by multiplex immunofluorescence, formalin-fixed paraffinembedded (ffpe) tissue, algorithmic analyses to determine tumor-recurrence risk score |
| 0598U | Gastroenterology (irritable bowel syndrome), igg antibodies to 18 food items by microarray-based immunoassay, whole blood or serum, report as elevated (positive) or normal (negative) antibody levels |
| 0599U | Oncology (pancreatic cancer), multiplex immunoassay of icam1, timp1, ctsd, thbs1, and ca 19-9, serum, diagnostic algorithm reported as positive or negative |
Deleted Codes
| HCPCS | DESCRIPTION |
|---|---|
| C9088 | Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg |
| C9174 | Injection, datopotamab deruxtecan-dlnk, 1 mg |
| C9175 | Injection, treosulfan, 50 mg |
| C9248 | Injection, clevidipine butyrate, 1 mg |
| J2150 | Injection, pegaptanib sodium, 0.3 mg |
| J2503 | Injection, cefotetan disodium, 500 mg |
| 0450U | Test for monoclonal paraproteins in blood, results reported as a baseline presence or absence of detectable clonotypic peptides in multiple myeloma |
| 0451U | Testing paraproteins in blood, results compared to baseline results to determine monoclonal paraprotein abundance in multiple myeloma |
Source
Transmittal 13249, CR 14079 dated May 29, 2025
Last Updated Sep 18 , 2025
