December 2023 Content Release Copied
Clinical Profile Documentation
Additions
The Problems > Add Details area is updated with applicable documentation points for the following diagnoses.
AKT1 is now available for Breast Cancer with the following documentation points:
- Wild-type
- Mutation
- Unknown
PSMA is now available for Prostate Cancer with the following documentation points:
- Positive
- Negative
- Not performed
PTEN is now available for Breast Cancer with the following documentation points:
- Wild-type
- Mutation
- Unknown
Problems
Additions
New items are available for documentation in Problems and appear in the Charge Capture Report (CCR). Additional ICD-10 codes* may be displayed to present the surrounding nodes.
Lab Analytes & Panels
Additions
- Beta HCG, U/L
- Dabigatran (Pradaxa) interpretation
- EBV DNA PCR, quant, log IU/mL
- GFR female
- GFR male
- Herpes virus 6 DNA PCR, quant, copies/mL
- Lyme Disease ab, IgG, blot
- Lyme Disease ab, IgM, blot
- Prealbumin, mg/L
- RBC antigen 1
- RBC antigen 2
- RBC antigen 3
- RBC antigen 4
- RBC antigen 5
- Respiratory culture
- BA3071 invest IV
- Chiauranib invest Oral
- CHM-1101 invest Intratumoral
- CHM-1101 invest Intraventricular
- ERAS-254 invest Oral
- FF-10832 invest IV
- Gemcitabine Liposome invest (FF-10832 invest IV)
- IDE161 invest Oral
- MT-8421 invest IV
- Naporafenib invest (ERAS-254 invest Oral)
- RNK05047 invest IV
- Sodium Citrate IV
- ZW25 invest or JZ598 invest IV
- Zanidatamab invest (ZW25 invest or JZP958 invest IV)
Updates
| Medication | Update |
| Budigalimab invest (ABBV-181 invest IV) | Obsolete Form: 100 mg solution
New Form available:100 mg recon soln |
| Ferric Carboxymaltose IV | New default sig: 750 mg intravenously once; administer over 15 minutes; admixture fluid 250 ml of 0.9 % Sodium Chloride
New Maximum Single Dose: 1000 mg New Instructions available: May also give undiluted by slow IV Push at a rate of approximately 100 mg (2 mL) per minute or 15 minutes for 1,000 mg dose. Observe for signs and symptoms of hypersensitivity reactions for at least 30 minutes following the administration. For iron deficiency anemia, if weight less than 50 kg the recommended dose is 15 mg/kg. |
| Fruzaqla (fruquintinib Oral) | New Maximum Single Dose: 5 mg |
| Fruzaqla invest (HMPL-013 invest Oral) Nirogacestat invest Oral | No longer available to order |
| Oxycodone Oral Liquid | Inactive default sig: 5 mL orally every 4 to 6 hours prn pain; quantity sufficient for 12 days
New default sig available: 5 mL orally every 4 to 6 hours prn pain; quantity sufficient for 10 days |
| TJ033721 invest IV | New Form available: 200 mg/4 mL (50 mg/mL) solution |
| TTX-030 invest IV | New Form available: 30 mg/mL solution |
Regimen Library
Nyvepria™ Precheck in Long-Acting G-CSF-containing Regimens
After reviewing utilization trends, economics, and commercial coverage, the P&T Executive Committee voted to precheck Nyvepria™ (pegfilgrastim-apgf) in all regimens containing long- acting G-CSFs. All regimens have been updated with the December content release.
Additions
| Regimen Name | Diagnosis |
| Amivantamab-vmjw (weight less than 80 kg) + Pemetrexed + Carboplatin Q21D | Lung Cancer, Non-small Cell (NSCLC) |
| Amivantamab-vmjw (weight less than 80 kg) + Pemetrexed Q21D Maintenance | Lung Cancer, Non-small Cell (NSCLC) |
| Amivantamab-vmjw (weight greater than or equal to 80 kg) + Pemetrexed + Carboplatin Q21D | Lung Cancer, Non-small Cell (NSCLC) |
| Amivantamab-vmjw (weight greater than or equal to 80 kg) + Pemetrexed Q21D Maintenance | Lung Cancer, Non-small Cell (NSCLC) |
| Capivasertib + Fulvestrant Q28D | Breast Cancer |
| Fruquintinib Q28D | Colon Cancer; Rectal Cancer |
| Mirikizumab-mrkz IV (Induction) fb SQ (Maintenance) Q28D | Ulcerative Colitis |
| Nirogacestat Q30D | Desmoid Fibromatosis |
| Repotrectinib Q30D | Lung Cancer, Non-small Cell (NSCLC) |
| Rituximab IV D1,15 + Vemurafenib Q28D (Part 2 of 2: Rituximab Consolidation) | Leukemia, Hairy Cell |
| Rituximab IV D1,15,29,43 + Vemurafenib D1- 56 (Part 1 of 2: Induction) | Leukemia, Hairy Cell |
| Toripalimab-tpzi (Flat Dose) + Gemcitabine D1,8 + Cisplatin Q21D (Part 1 of 2) | Head and Neck Cancer (Parent) |
| Toripalimab-tpzi Q21D (Flat Dose) (Part 2 of 2: Maintenance) | Head and Neck Cancer (Parent) |
| Toripalimab-tpzi (3 mg/kg) Q14D | Head and Neck Cancer (Parent) |
Updates
Regimens for the following diagnoses have been updated based on the Collaborative Care Committee voting. Changes include reference updates, drug infusion instruction updates, renaming regimens, premedication template updates and number of cycles.
- Anal Cancer (Parent)
- Brain Tumor (Parent)
- Breast Cancer
- Colon Cancer
- Leukemia, Acute Lymphocytic (ALL)
- Leukemia, Acute Myeloid (AML)
- Leukemia, Acute Promyelocytic (APL)
- Lymphoma, Hodgkin (HL)
- Lymphoma, Non-Hodgkin (NHL) (Parent)
- Bile Duct Cancer (Parent)
- Colon Cancer
- Esophageal Cancer (Parent)
- Gallbladder Cancer
- Gastric Cancer
- Neuroendocrine Tumor, Carcinoid (Parent)
- Pancreatic Cancer
- Pancreatic Cancer, Carcinoid/Neuroendocrine
- Rectal Cancer
- Waldenstrom’s Macroglobulinemia
Renames
| Previous Name | New Name |
| Intrathecal Chemotherapy | Intrathecal Therapy |
Research
Updates
| Updated Reference Information | Updated Drug Service Order Information | Updated Regimen Instructions | Other Changes | |
| USOR 19043 | X | X | ||
| USOR 20138 | X | X | X | Now available: USOR 20138 Continued Access Phase Capivasertib + Abiraterone + Prednisone |
| USOR 20270 | X | |||
| USOR 21318 | X | No longer available:
USOR 21318 Entrectinib (PO; Daily) Q28D USOR 21318 Pralsetinib (PO; Daily) Q28D |
||
| USOR 21537 | X | |||
| USOR 21541 | X | X | X | |
| USOR 22041 | X | X | X | |
| USOR 22052 | X | |||
| USOR 22073 | X | X | ||
| USOR 22088 | X | X | X | |
| USOR 22159 | X | X | ||
| USOR 22167 | X | |||
| USOR 22229 | X | X | X | |
| USOR 22331 | X | X | X | |
| USOR 23016 | X | |||
| USOR 23027 | X | |||
| USOR 23087 | X | X | X | |
| USOR 23172 | X | X | X | Now available: USOR 23172 Cohort B Induction Phase Futibatinib (PO; Daily) + Pembrolizumab + mFOLFIRINOX Q14D |
Billing & HCPCS Codes
2024 AMA CPT Updates
The 2024 CPT updates include:
- Added: 230
- Deleted: 49
- Revised: 70
CMS-Hierarchical Condition Categories (HCC)
The CMS HCC model is now on Version 28; For a complete list of ICD-10-CM codes please visit CMS Risk Adjustment 2024 Model Software/ICD-10 Mappings.
HCPCS Updates
The January 2024 updates include new HCPCS Level II codes to separately identify products approved under the 505(b)(2) New Drug Application (NDA) or the Biologics License Applications (BLA) pathways after October 2003, and not rated as therapeutically equivalent to a reference listed product in an existing code. A complete application summary and coding link can be found here.
For a complete list of January 2024 HCPCS quarterly updates, please visit CMS’s website.
The following products have not been released into the marketplace:
- Docetaxel (Ingenus)
- Daxibotulinumtoxina-lanm
- Methotrexate (Accord)
- Paclitaxel protein-bound particles (Teva)
- Pemetrexed (Pemrydi rtu)
| Medication | HCPCS Codes |
| Adalimumab-afzb (Abrilada) | Q5132 per 10 mg |
| Amisulpride | J0184 per 1 mg |
| Aripiprazole (Abilify Asimtufii) | J0402 per 1 mg |
| Artesunate | J0391 per 1 mg |
| beremagene geperpavec-svdt Topical Gel 5 x 10exp9 PFU/2.5 mL | J3401 per 0.1 mL |
| Bumetanide | J1939 per 0.5 mg |
| Bortezomib (Maia) *Effective 10/1/23 | J9051 per 0.1 mg |
| Buprenorphine Subcutaneous ER Solution | J0576 per 1 mg |
| Carmustine (Accord), not therapeutically equivalent to j9050 | J9052 per 100 mg |
| Cefazolin sodium (Hikma), not therapeutically equivalent to j0690 | J0688 per 500 mg |
| Cyclophosphamide (Dr. Reddy’s) | J9072 per 5 mg |
| Daptomycin (Xellia) not therapeutically equivalent to j0878 | J0873 per 1 mg |
| Delandistrogene Moxeparvc-rokl | J1413 per 1 mL |
| Dexmedetomidine Buccal Film Dexmedetomidine Sublingual Film | J1105 per 1 mcg |
| Efgartigimod-hyaluronidase-qvfc Subcutaneous 1,008 mg-11,200 unit/5.6 mL | J9334 per 2 mg |
| Emtricitabine-Tenofovir Oral 200 mg-25 mg | J0751 per 1 tab |
| Emtricitabine-Tenofovir Oral 200 mg-300 mg | J0750 per 1 tab |
| Epcoritamab-bysp Subcutaneous | J9321 per 0.16 mg |
| Fludeoxyglucose F-18 | A9609 per 15 mci |
| Fluoroestradiol F-18 IV 148 MBq/mL to 3,700 MBq/mL | A9608 per 1 mci |
| Fluphenazine IM | J2679 per 1.25 mg |
| Hydroxocobalamin IM | J3425 per 10 mcg |
| Glofitamab-gxbm | J9286 per 2.5 mg |
| Glycopyrrolate | J1596 per 0.1 mg |
| Nicardipine IV | J2404 per 0.1 mg |
| Pegunigalsidase alfa-iwxj | J2508 per 1 mg |
| Risperidone (Uzedy) | J2799 per 1 mg |
| Rozanolixizumab-noli | J9333 per 1 mg |
| Secukinumab Subcutaneous | J3590 per 150 mg |
| Sincalide (maia) | J2806 per 5 mcg |
| Talquetamab-tgvs | J3590 per:
|
| Tirzepatide (weight loss) Subcutaneous Pen | J3490 per 5 mg |
| Tofersen Intrathecal | J1304 per 1 mg |
| Toripalimab-tpzi (Loqtorzi) | J9999 per 240 mg |
| Valoctocogene roxaparvovc-rvox IV (Roctavian) | J1412 per 1 mL |
| Velmanase alfa-tycv | J0217 per 1 mg |
NDC to HCPCS Crosswalk
Additions
| Medication (Brand) | HCPCS Code | NDC |
| Aripiprazole (Abilify Asimtufii) | J0402 | 59148010280 59148011480 |
| Carmustine (Accord) | J9052 | 16729054863 16729054305 16729054601 16729054563 |
| Cefazolin sodium (Hikma) | J0688 | 00143914025 00143914001 00143913925 00143913901 |
| Cyclophosphamide (Dr. Reddy’s) | J9072 | 43598066211 43598066011 43598066111 |
| Daptomycin (Xellia) | J0873 | 70594005301 |
| Sincalide (maia) | J2806 | 72266024801 72266024805 |