June 2025 Content Release Copied

06/26/20252025 ContentContent releasePhysician, Clinical, Admin, Billing

Problem Groups

Additions

The Problems > Add Details area is updated with applicable documentation points for the following diagnoses.

c-Met overexpression status is now available for Lung Cancer, Non-small cell (NSCLC) with the following documentation points:

  • 3+ intensity AND >/= 50%
  • <3+ intensity OR <50%
  • Unknown

CD30 status has been updated for Lymphoma, Hodgkin (HL) and Lymphoma, Non-Hodgkin (NHL) (Parent) with the following documentation points:

  • Positive
  • Negative
  • Unknown

ERBB2 (HER2) is no longer available for documentation in Colon and Rectal Cancers.

Germline VHL alteration status has been updated for Neuroendocrine Tumor, Carcinoid (Parent) and Renal Cell Carcinoma (RCC) with the following documentation points:

  • Pathogenic, or likely pathogenic
  • Negative
  • Variant of uncertain significance
  • Unknown

HLA-A*02.01 status has been updated for Melanoma, Uvea, Ciliary Body/Choroid with the following documentation points:

  • Positive
  • Negative
  • Unknown

HRRm/HRD (non-BRCA) status has been updated for Prostate Cancer with the following documentation points:

  • Positive
  • Negative
  • Unknown

Homologous recombination (HR) status has been updated for Fallopian Tube and Ovarian and Primary Peritoneal Cancers with the following documentation points:

  • Deficient
  • Proficient
  • Other non-actionable finding
  • Unknown

IDH1 status has been updated for Bile Duct Cancer (Parent), Gallbladder Cancer, Leukemia, Acute Myeloid (AML), and Myelodysplastic Syndrome (MDS) with the following documentation points:

  • Mutation
  • Wild type
  • Other non-actionable finding
  • Unknown

KRAS status is now available for Fallopian Tube Cancer and Ovarian and Primary Peritoneal Cancer with the following documentation points:

  • KRAS G12C mutation
  • Other KRAS mutation
  • Wild type
  • Unknown

Oncotype Dx Recurrence Score has been updated for Breast Cancer with the following documentation points:

  • < or = 15
  • 16-25
  • > or = 26
  • Unknown

PALB2 status has been updated for Pancreatic Cancer with the following documentation points:

  • Mutation
  • Wild type
  • Unknown

t(11;14) translocation status has been updated for Leukemia, Chronic Lymphocytic (CLL),  Lymphoma, Non-Hodgkin (NHL), CLL/SLL, and Plasma Cell Disorder (Parent) with the following documentation points:

  • Positive
  • Negative
  • 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

  • 2,3 bisphosphoglycerate mutation panel
  • Add-on preliminary-evidence colorectal cancer guidelines genes; Invitae hereditary colorectal cancer guidelines-based panel; Invitae multi-cancer panel
  • Amikacin, peak, mg/L
  • AMPA-R Ab CBA, CSF
  • Amphiphysin Ab, CSF
  • Aspergillus glaucus IgG
  • Aspergillus nidulans IgG
  • Aspergillus terreus IgG
  • BCL-1 t(11;14) by PCR panel
  • BPGMM gene sequencing result
  • BPGMM interpretation
  • CASPR2-IgG CBA, CSF
  • CBFB-MYH11(INV16) panel
  • Chromosome analysis, cyto bone marrow additional information
  • CLL FISH, bone marrow panel
  • CLL, blood panel
  • CLL-FISH blood NeoType panel
  • ClonoSEQ – adaptive coordinates specimen retrieval (id only) panel
  • ClonoSEQ – blood in EDTA (includes MRD and/or ID tests) panel
  • ClonoSEQ – ctDNA- blood in streck (DLBCL only; includes MRD and/or ID tests) panel
  • ClonoSEQ – fresh bone marrow (includes MRD and/or ID tests) panel
  • Compass select without flow cytometry with clonoSEQ panel
  • Compass select without flow cytometry without clonoSEQ panel
  • Copper, plasma and RBC panel
  • Copper, plasma, ug/mL
  • CXC R4 mutation panel
  • Cyclic citrullinated peptide (CCP) antibodies, IgA, IgG panel
  • DPPX Ab CBA, CSF
  • DPPX AB CBA, S
  • Encephalopathy, autoimmune/paraneoplastic evaluation, CSF panel
  • Encephalopathy, autoimmune/paraneoplastic evaluation, serum panel
  • Encephalopathy, interpretation, CSF
  • FIB-4 index panel with reflex to enhanced liver fibrosis (ELF) score panel
  • FLCN panel
  • Flow cytometry, bone marrow panel
  • Flow cytometry, peripheral blood panel
  • Foundation Medicine IHC Only panel
  • GABA-B-R Ab CBA, CSF
  • GAD65, CSF – nmol/L
  • Ganglioside antibodies interpretation
  • GFAP IFA, CSF
  • Guardant Hereditary Cancer panel
  • HEMP EPOR gene sequencing result
  • HEMP HIF2A gene sequencing result
  • HEMP molecular interpretation
  • HEMP PHD2 gene sequencing result
  • HEMP reviewed by
  • Hereditary erythrocytosis gene panel, next-generation sequence (HEMP) panel
  • Herpes simplex virus (HSV) and varicella zoster virus (VZV) panel
  • Hgb A2 reflex to HPLC
  • HLA B58:01, allopurinol hypersensitivity panel
  • HNA antibodies
  • HNA antibodies clinical relevance
  • HNA antibodies electronic signature
  • HNA antibodies electronic signature
  • HNA antibodies methodology
  • HNA antibodies panel
  • HNA antibodies reference
  • HPV, low risk by ISH
  • HPV, low risk comment
  • HTLV I/II, qualitative panel
  • Human transforming growth factor beta1 (TGF-B1), pg/mL
  • IFA notes, CSF
  • IgLON5 CBA, CSF
  • IgVH bone marrow panel
  • IGVH mutation specimen status
  • Invitae MUTYH panel
  • JAK2 exon 12 mutation indications
  • JAK2 mutation (V617F) analysis, plasma-based, Leumeta panel, quan
  • JAK2 V617F mutation analysis panel, qual
  • Leukemia /lymphoma clinical information
  • Leukemia /lymphoma clinical information
  • Leukemia /lymphoma final diagnosis
  • Leukemia /lymphoma final diagnosis
  • Leukemia /lymphoma flow cell population data
  • Leukemia /lymphoma flow cell population data
  • Leukemia /lymphoma flow disclaimer
  • Leukemia /lymphoma flow disclaimer
  • Leukemia /lymphoma interpretation-FC
  • Leukemia /lymphoma interpretation-FC
  • Leukemia/lymphoma report header
  • Leukemia/lymphoma report header
  • LGI1- IgG CBA, CSF
  • Lymphoid NGS panel
  • mGluR1 Ab IFA, CSF
  • Microalbumin, random urine panel
  • MPN FISH, global only panel
  • MPN FISH, tech panel
  • Multiple myeloma FISH, global panel
  • Multiple myeloma FISH, tech panel
  • MXD#, 10×3/uL
  • Neo Comprehensive – heme cancers DNA ONLY panel
  • Neo Comprehensive-myeloid disorders panel
  • NeoType MDS/CMML panel
  • Neurochondrin IFA, CSF
  • Neurochondrin IFA, S
  • NIF IFA, CSF
  • NIF IFA, S
  • NMDA-R Ab CBA, CSF
  • PCA-2, CSF
  • PDE10a Ab IFA, CSF
  • PhenoSense GT plus integrase genotype results
  • PhenoSense GT plus integrase phenotype results
  • Protein Electrophoresis
  • REVE2, erythrocytosis evaluation panel
  • REVE2, erythrocytosis interpretation
  • Rubella Ab IgG panel
  • S-100B protein, serum panel
  • S-100B protein, serum, ng/L
  • Septin-7 IFA, CSF
  • Septin-7 IFA, S
  • SPE
  • SPEP
  • TRIM46 Ab IFA, CSF
  • TRIM46 AB IFA, S

Medications

Additions

  • BGB-43395 invest Oral
  • BI 770371 invest IV
  • BNT324/DB-1311 invest IV
  • Necitumumab IV
  • ONO-4578 invest Oral
  • PDS0101 (3.0 mg Versamune and 2.7 mg HPVmix) invest Subcutaneous
  • PF-07248144 invest Oral
  • PT199 invest IV
  • RLY-2608 invest Oral
  • TSC-202-A0201 invest IV
  • TUB-040 invest IV
  • ZL-1310 invest IV

Updates

Medications Updates
Avutometinib Oral Old Instructions removed:

  • Avutometinib 3.2 mg orally 2 times per week for 3 wks; take twice weekly on days 1 and 4 during weeks 1 through 3 of each 4-week cycle; per protocol with defactinib

New Instructions available:

  • avutometinib 3.2 mg orally 2 times per week; Take 2x/week on days 1 and 4 during weeks 1 through 3 of each 4-week cycle; per protocol with defactinib
  • avutometinib 3.2 mg orally As Directed
  • avutometinib 3.2 mg orally Per package directions
  • avutometinib 2.4 m.g orally 2 times per week; Take 2x/week on days 1 and 4 during weeks 1 through 3 of each 4-week cycle; per protocol with defactinib
  • avutometinib 2.4 mg orally As Directed
  • avutometinib 2.4 mg orally Per package directions
  • Take with food.
avutometinib-defactinib Combo Pack 0.8 mg-200 mg Old Instructions removed:

  • AVUTOMETINIB: take 4 capsules by mouth once daily on days 1 and 4 during weeks 1-3; DEFACTINIB: take 1 tablet by mouth twice daily during weeks 1-3

New Instructions available:

  • Take with food.
AZD2936 invest IV New Alias available:

  • Rilvegostomig invest
Fakzynja (defactinib Oral) New Maximum Single Dose available:

  • 200 mg

New Instructions available:

  • Take 2x/day during weeks 1 through 3 of each 4-week cycle; per protocol with avutometinib. Take with food.
Ferric Derisomaltose IV New BSA Weight of 50 kg available for the following SIGs:

  • Ferric Derisomaltose 20 mg/kg intravenously Piggyback once
  • Ferric Derisomaltose 20 mg/kg intravenously once
MK-2870 invest IV New Alias available:

  • Sacituzumab tirumotecan invest

New Quick SIG Options available:

  • 24 mg/kg intravenously every 2 weeks; Final concentration 0.5-5.0. Administer over 90 minutes (+/- 15 minutes)
  • 3 mg/kg intravenously once
MRTX1719 invest Oral New Form available:

  • 50 mg tablet
Necitumumab IV Medication has been Reactivated.
ocrelizumab-hyaluronidase-ocsq Subcutaneous 920 mg-23,000 unit/23 mL New Quick SIG Options available:

  • 0 mg subcutaneously once
ocrelizumab-hyaluronidase-ocsq Subcutaneous 920 mg-23,000 unit/23 mL New Maximum Single Dose available:

  • 920 mg

New default SIG available:

  • 920 mg subcutaneously once

New Route available:

  • Via continuous subcutaneous infusion

New Instructions available:

  • FOR SUBCUTANEOUS ADMINISTRATION ONLY. Administer into the abdomen over 10 minutes using a subcutaneous infusion set containing a 24-26G needle and a priming volume 0.8 mL or less. Do NOT administer within 2 inches around the navel or into areas where the skin is red, bruised, tender, hard, or areas where there are moles or scars. Do NOT dilute or shake. Do NOT administer remaining priming volume after ocrelizumab-hyaluronidase-ocsq. Monitor patients during all injections and for at least one hour after the initial injection and for at least 15 minutes after subsequent injections.NOTE: This is Ocrevus Zunovo.
PF-06821497 invest Oral New Alias available:

  • Mevrometostat invest

New Quick SIG Options available:

  • 625 mg orally 2 times per day
  • 750 mg orally 2 times per day
  • 875 mg orally 2 times per day
Rilvegostomig invest IV Set inactive. Available Replacement:

  • AZD2936 invest IV
  • Rilvegostomig invest (AZD2936 invest IV)
telisotuzumab vedotin-tllv IV New Maximum Single Dose available:

  • 190 mg

New BSA Override with Weight available:

  • 100 kg

New Instructions available:

  • Dilute in NS to achieve a final concentration of 1 to 10 mg/mL.
    Gently invert to mix. Do not shake.
    Administer using a dedicated infusion line and 0.2 or 0.22-micron in-line polyether sulfone, polyvinylidene fluoride, or polyamide filter.
    Do not mix or administer with other drugs.NOTE: Telisotuzumab vedotin-tllv is a possible irritant.
TT-00420 invest Oral New Alias available:

  • Tinengotinib invest

Regimen Library

Additions

Regimen Name Diagnosis
Avutometinib + Defactinib Q28D Fallopian Tube Cancer; Ovarian and Primary Peritoneal Cancer
Nipocalimab-aahu IV Q14D ​​Myasthenia Gravis​
Ocrelizumab-hyaluronidase-ocsq Q6M ​​Multiple Sclerosis​
Pembrolizumab (Dose Banding) + Lenvatinib Q42D Dose Optimization ​​Uterine Cancer (Parent)​
Pembrolizumab (Flat Dose) + Paclitaxel D1,8,15,22,29,36 + Carboplatin D1,8,15,22,29,36 Q42D fb Pembrolizumab (Flat Dose) + Doxorubicin + Cyclophosphamide (AC) D1,15,29 Q42D Dose Dense Breast Cancer
Pembrolizumab (Flat Dose) + Paclitaxel D1,8,15,22,29,36 + Carboplatin D1,22 Q42D fb Pembrolizumab (Flat Dose) + Doxorubicin + Cyclophosphamide (AC) D1,15,29 Q42D Dose Dense Breast Cancer
Pembrolizumab + Lenvatinib Q21D Dose Optimization Uterine Cancer (Parent)​
Pembrolizumab + Lenvatinib Q42D Dose Optimization Uterine Cancer (Parent)​
Telisotuzumab vedotin-tllv (Emrelis) Q14D Lung Cancer, Non-small Cell (NSCLC)

Updates

Regimens for the following diagnoses have been updated based on the Collaborative Care Committee voting. Changes include but are not limited to reference update, drug infusion instruction updates, renaming of regimens, premedication template updates and number of cycles.

  • Anal Cancer (Parent)
  • Bile Duct Cancer (Parent)
  • Bladder Cancer
  • Breast Cancer
  • Cervical Cancer
  • Colon Cancer
  • Esophageal Cancer (Parent)
  • Gallbladder Cancer
  • Gastric Cancer
  • Head and Neck Cancer (Parent)
  • Leukemia, Chronic Lymphocytic (CLL)
  • ​​Lymphoma, Hodgkin (HL)​
  • Melanoma, Skin​
  • Neuroendocrine Tumor, Carcinoid (Parent)
  • Pancreatic Cancer
  • Pancreatic Cancer, Carcinoid/Neuroendocrine
  • Rectal Cancer
  • Renal Cell Carcinoma (RCC)​
  • Renal Pelvis and Ureter Cancer
  • Urethral Cancer​

Renames

Previous Name New Name
Nivolumab (3 mg/kg) + Ipilimumab (1 mg/kg) Q21D Nivolumab (3 mg/kg) + Ipilimumab (1 mg/kg) C1 D1,22,43,64 (Q21D) followed by Nivolumab C2+ D1,29,57 (Q28D) Maintenance Q84D

Billing & HCPCS Codes

Updates

The July 2025 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 on the CMS website.

Please visit CMS’s website for a complete list of July 2025 HCPCS Quarterly update.

The following products have not been released, per First Databank (FDB):

  • J9174 – docetaxel (beizray)
  • J9274 – cosibelimab-ipdl
  • Q5098 – ustekinumab-srlf (imuldosa)
  • Q5153 – aflibercept-yszy (opuviz)

Additions

Medication HCPCS Codes
telisotuzumab vedotin-tllv IV J9999 per 100 mg
atezolizumab-hyaluronidase-tqjs Subcutaneous 1,875 mg-30,000 unit/15 mL J9024 per 15 mL
aztreonam-avibactam IV 2 gram J3490 per 2 g
denosumab-bbdz Subcutaneous (60 mg/mL – Jubbonti) Q5136 per 1 mg
efbemalenograstim alfa-vuxw Subcutaneous J9361 per 0.5 mg
mening vac A,C,Y,W135,tet (PF) IM 10 mcg/0.5 mL 90619 per 0.5 mL
nipocalimab-aahu IV J3590 per 185 mg

The following HCPCS codes will be effective July 1, 2025.

Medication HCPCS Codes
Atidarsagene autotemcel IV J3391 per tx
Calcium Chloride IV J0618 per 2 mg
Diltiazem IV J1163 per 0.5 mg
Epinephrine (PF) IM J0165
J0166
J0167 per 0.1 mg
J0168
J0169
Epinephrine (PF) IV J0165
J0166
J0167 per 0.1 mg
J0168
J0169
Epinephrine (PF) Subcutaneous J0165
J0166
J0167 per 0.1 mg
J0168
J0169
Epinephrine IM J0165
J0166
J0167 per 0.1 mg
J0168
J0169
Epinephrine IM Pen Injector 0.15 mg/0.3 mL (1:2,000) (Ped) J0165
J0166
J0167 per 0.1 mg
J0168
J0169
Epinephrine IM Pen Injector 0.3 mg/0.3 mL (1:1,000) (Adult) J0165
J0166
J0167 per 0.1 mg
J0168
J0169
Epinephrine IV J0165
J0166
J0167 per 0.1 mg
J0168
J0169
Epinephrine Subcutaneous J0165
J0166
J0167 per 0.1 mg
J0168
J0169
Epinephrine Subcutaneous Pen Injector 0.15 mg/0.3 mL (1:2,000) (Ped) J0165
J0166
J0167 per 0.1 mg
J0168
J0169
Epinephrine Subcutaneous Pen Injector 0.3 mg/0.3 mL (1:1,000) (Adult) J0165
J0166
J0167 per 0.1 mg
J0168
J0169
Foscarbidopa-foslevodopa Continuous Subcutaneous Infusion J7356 per 5 mg
Foscarbidopa-foslevodopa Subcutaneous J7356 per 5 mg
Indigotindisulfonate IV J9220 per:

  • 1 mg
  • 0.125 mL
Marstacimab-hncq Subcutaneous Pen Injector J7172 per 0.5 mg
Metoprolol IV J0616 per 1 mg
Naloxone IM J2312 per 0.01 mg

J2313 per 0.01 mg
Naloxone IM Auto-Injector J2312 per 0.01 mg
Naloxone IV J2312 per:

  • 0.01 mg
  • 10 mcg
Naloxone Subcutaneous J2312 per 0.01 mg
J2313 per 0.01 mg
Naloxone Subcutaneous Auto-Injector J2312 per 0.01 mg
nivolumab-hyaluronidase-nvhy Subcutaneous 600 mg-10,000 unit/5 mL J9289 per:

  • 2 mg
  • 0.016667 mL
Obecabtagene autoleucel IV Q2058 per 400 x 10e6 CARpos viable T cells
Thiotepa IM J9342 per 1 mg
Thiotepa IV J9341 per 1 mg
J9342 per 1 mg
Ustekinumab-kfce IV Q5100 per 1 mg
Ustekinumab-kfce Subcutaneous Q5100 per 1 mg
Ustekinumab-stba IV Q5099 per 1 mg
Ustekinumab-stba Subcutaneous Q5099 per 1 mg
Vancomycin IV J3373
J3374 per 10 mg & 0.01 g
J3375
Zanidatamab-hrii J9276 per 2 mg
Zenocutuzumab-zbco IV J9382 per 1 mg
Zolbetuximab-clzb IV J1326 per 2 mg

Removals

The following HCPCS codes will be discontinued on June 30, 2025.

Medication HCPCS Codes
Naloxone IM J2310 per 1 mg
J2311 per 1 mg
Naloxone IM Auto-Injector J2310 per 1 mg
Naloxone IV J2310 per 1 mg
Naloxone Subcutaneous J2310 per 1 mg
J2311 per 1 mg
Naloxone Subcutaneous Auto-Injector J2310 per 1 mg
Thiotepa IM J9340 per 15 mg
Thiotepa IV J9340 per 15 mg
Vancomycin IV J3370
J3371       per 500 mg
J3372

NDC – HCPCS Crosswalk

Updates

The CMS ASP pricing can be found at the following website: https://www.cms.gov/medicare/payment/part-b-drugs/asp-pricing-files

Additions

The following HCPCS codes and NDCs will be effective July 1, 2025.

Medication (Brand) HCPCS Codes NDC
Naloxone IM (Zimhi) J2313 per 0.01 mg 78670014002, 78670014011
Naloxone Subcutaneous (Zimhi) J2313 per 0.01 mg 78670014002, 78670014011
Vancomycin IV (Mylan) J3374 per 10 mg 67457070500, 67457070575, 67457082225, 67457082299, 67457082312, 67457082399, 67457082415, 67457082499, 72078006550, 72078006599, 72078006650, 72078006699
Vancomycin IV (Xellia) J3375 per 10 mg 70594004101, 70594004103, 70594004201, 70594004203, 70594004301, 70594004302, 70594004401, 70594004402, 70594005601, 70594005603, 70594005701, 70594005702, 70594005801, 70594005802
Thiotepa IV (Tepylute) J9341 per 1 mg 81927010601, 81927010501

Removals

The following HCPCS codes and NDCs will be discontinued on June 30, 2025:

Medication (Brand) HCPCS Codes NDC
Naloxone IM (Zimhi) J2311 per 0.01 mg 78670014002, 78670014011
Naloxone Subcutaneous (Zimhi) J2311 per 0.01 mg 78670014002, 78670014011
Vancomycin IV (Mylan) J3371 per 500 mg 67457070500, 67457070575, 67457082225, 67457082299, 67457082312, 67457082399, 67457082415, 67457082499, 72078006550, 72078006599, 72078006650, 72078006699
Vancomycin IV (Xellia) J3372 per 500 mg 70594004101, 70594004103, 70594004201, 70594004203, 70594004301, 70594004302, 70594004401, 70594004402, 70594005601, 70594005603, 70594005701, 70594005702, 70594005801, 70594005802