March 2024 Content Release Copied

03/28/20242024 ContentContent releasePhysician, Clinical, Admin, Billing

Problem Groups

Additions

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

Line of Therapy of Non-muscle invasive bladder cancer (NMIBC) is now available for Bladder Cancer.

ESR1 mutation after 1st line endocrine therapy (NCCN recommends re-testing at progression following prior lines of endocrine therapy) is now available for Breast Cancer with the following documentation points:

  • Detected
  • Not detected
  • Unknown

HLA-A*02:01 is now available for Melanoma, Uvea, Ciliary Body/ Choroid with the following documentation points:

  • Positive
  • Negative
  • Ordered: result pending
  • Not performed

MSI (Microsatellite Instability) and MMR (Mismatch Repair) are now available for Bile Duct Cancer (Parent) with the following documentation points:

  • MSI (Microsatellite Instability)
    • Low
    • Stable
    • High
    • Indeterminate
    • Ordered: Results pending
    • Unknown
  • MMR (Mismatch Repair)
    • Deficient
    • Proficient
    • Unknown

Lab Analytes & Panels

Additions

  • 7/7q by FISH
  • 7/7q by FISH panel
  • Alpha-1-antitrypsin, fecal, Qn
  • Ammonia, umol/L
  • ANA Ab HEp-2 substrate panel
  • ANA cytoplasmic pattern
  • Atyp mononuclear cells, %
  • B-cell lymphoma, Fish, tissue additional information
  • B-Cell lymphoma, FISH, tissue panel
  • BCL2,T(14;18), FISH
  • BCR/ABL, P190 final diagnosis
  • BCR/ABL, P190 quant monitor (monitoring) panel
  • BCR/ABL, P190 result
  • BCR/ABL, P190 specimen
  • BKV PCR viral log, log IU/ml
  • Blood gas, arterial panel
  • Cannabidiol, ng/mL
  • Caris assure liquid panel
  • Caris liquid assure report
  • Caris liquid assure report panel
  • Chromosome analysis, cytogenetics additional information
  • Chromosome analysis, cytogenetics banding method
  • Chromosome analysis, cytogenetics interpretation
  • Chromosome analysis, cytogenetics method
  • Chromosome analysis, cytogenetics reason for referral
  • Chromosome analysis, cytogenetics released by
  • Chromosome analysis, cytogenetics result
  • Chromosome analysis, cytogenetics result summary
  • Chromosome analysis, cytogenetics specimen
  • Chromosome analysis, cytogenetics, blood panel
  • CLL FISH additional information
  • CLL FISH disclaimer
  • CLL FISH method
  • CLL FISH reason for referral
  • CLL FISH result
  • CLL FISH result summary
  • CLL FISH result table
  • CMV DNA (log10), log10
  • CMV DNA PCR, IU/mL
  • COMPASS select without flow cytometry (no NeoType testing) panel
  • COMPASS select without flow cytometry panel
  • Covid antigen panel
  • Covid antigen, qual
  • Cryofibrinogen, 5 days
  • Culture, wound, aerobic panel w/ gram stain
  • Cytomegalovirus (CMV), DNA, Ultraquant panel
  • Drug screen 11 w/reflex conf, blood panel
  • Eosinophils, smear, urine
  • EVB PCR Log10
  • Fibrinogen activity panel, clauss
  • Flow cytometry specimen information
  • Gastric parietal antibody panel
  • pylori, PCR stool clarithromycin resistance result
  • pylori, PCR stool panel
  • pylori, PCR stool result
  • pylori, PCR stool specimen
  • HBV DNA PCR, Log10
  • HCG, quantitative, serum panel
  • Histoplasma/blastomyces Ag result
  • Histoplasma/blastomyces Ag value, ng/mL
  • Histoplasma/blastomyces Ag, EIA, serum panel
  • Hormone Receptor
  • HPC sterility test
  • HPC sterility test panel
  • Immunoglobulin gene rearrangement panel
  • Immunohistochemistry panel
  • JAK2 Exon 12-15 final diagnosis
  • JAK2 sequencing result
  • cell lymphoma BCL6 FISH
  • tuberculosis PCR, respiratory only
  • tuberculosis PCR, respiratory only panel
  • Molecular results
  • Myeloma staging, blood panel
  • Myeloma, FISH bm released by
  • Myeloma, FISH panel, bone marrow
  • OnkoSight ACL neoplasm NGS therapeutics and prognostic assoc
  • OnkoSight advanced chronic lymphoid neoplasm NGS detailed genetic interpretation 1
  • Onkosight advanced chronic lymphoid neoplasm NGS panel
  • OnkoSight advanced chronic lymphoid neoplasm NGS references 2
  • OnkoSight advanced chronic lymphoid neoplasm NGS technical summary
  • OnkoSight advanced chronic lymphoid neoplasm NGS text box
  • OnkoSight advanced NGS myeloid allele frequencies
  • OnkoSight Advanced NGS Myeloid Panel
  • OnkoSight advanced NGS myeloid references 2
  • OnkoSight advanced NGS myeloid therapeutics and prognostic assoc
  • Parvovirus B19 Ab interpretation
  • Path blood smear consult clin question
  • Path blood smear consult diagnosis
  • Peripheral smear review w/ Pathologist consult panel
  • Pm/scl 100 Ab panel
  • Pm/scl 100 Ab, EIA, units
  • Semi-quant IHC, manual, tissue, 22c3
  • Semi-quant IHC, manual, tissue, 22c3 panel
  • Susceptibility AFB, rapid grower
  • Transfusion consult
  • Transfusion consult panel
  • Troponin T delta difference, ng/L

Medications

Additions

  • AZD0305 invest IV
  • BB-1701 invest IV
  • DSP-5336 invest Oral
  • EIK1001 invest IV
  • HC-7366 invest Oral
  • MK-2870 invest IV

Updates

Medication Update
BI 1810631 invest Oral New synonym available: Zongertinib invest
MEDI5752 invest IV New synonym available: Volrustomig invest
pegfilgrastim-cbqv Subcutaneous (via wearable injector) New Maximum Single Dose available: 6 mg New instructions available: May be applied by a healthcare professional on the same day as chemotherapy or the last day of chemotherapy in a multi-day regimen using only the co-packaged pegfilgrastim-cbqv. The device must be applied to patient’s skin (abdomen or back of arm). Usually applied to the abdomen, the back of arm should only be used if there is a caregiver available to monitor the injector. Pegfilgrastim-cbqv will begin infusing approximately 27 hours later and deliver pegfilgrastim-cbqv over 5 minutes.

NOTE: This is Udenyca On Body Injector.

Regimen Library

Udenyca OBI

Udenyca Onbody (pegfilgrastim-cbqv Subcutaneous (via wearable injector)) was added as an unchecked option within applicable regimen templates.

Additions

Regimen Name Diagnosis
BrECADD Lymphoma, Hodgkin (HL)
Cyclophosphamide IV + Bortezomib + Dexamethasone (CyBorD) Q28D (MM) Multiple Myeloma (MM)
Daratumumab SQ + Cyclophosphamide IV + Bortezomib + Dexamethasone (CyBorD) Q28D (Amyloidosis) (Part 1 of 2) Amyloidosis
Niraparib + Bevacizumab Q21D Ovarian and Primary Peritoneal Cancer; Fallopian Tube Cancer
Paclitaxel + XRT Q7D (Cervical, Uterine) Cervical Cancer; Uterine Cancer (Parent)
Ribociclib + Letrozole Q28D (Uterine) Uterine Cancer (Parent)

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.

  • All Problems
  • Amyloidosis
  • Breast Cancer
  • Cervical Cancer
  • Colon Cancer
  • Fallopian Tube Cancer
  • Leukemia, Hairy Cell
  • Lung Cancer, Non-small Cell (NSCLC)
  • Lymphoma, Hodgkin (HL)
  • Lymphoma, Non-Hodgkin (NHL) (Parent)
  • Multiple Myeloma (MM)
  • Multiple Sclerosis
  • Ovarian and Primary Peritoneal Cancer
  • Rectal Cancer
  • Uterine Cancer

Renames

Previous Name New Name
Daratumumab SQ + Cyclophosphamide PO + Bortezomib + Dexamethasone (CyBorD) Q28D (Amyloidosis) (Part 2 of 2: Daratumumab SQ only) Daratumumab SQ + Cyclophosphamide + Bortezomib + Dexamethasone (CyBorD) Q28D (Amyloidosis) (Part 2 of 2: Daratumumab SQ only)
Pegfilgrastim Pegfilgrastim Products
Teclistamab-cqyv SQ D1,8,15,22 Q28D (Maintenance) Teclistamab-cqyv SQ D1,8,15,22 fb D1,15 Q28D (Maintenance)

Research

Updates

Updated Reference Information Updated Drug Service Order Information Updated Regimen Instructions Other Changes
USOR 21176 X
USOR 21457 X X No longer available:

USOR 21457 Arm 2 Pembrolizumab Q21D

USOR 21457 Arm 3 Nemvaleukin alfa D1-5 Q21D
USOR 21498 X X X Now available:

USOR 21498 Avutometinib (BIW 3 on/1 off) + Sotorasib + Defactinib (BID 3 on/1 off) Q28D

USOR 21498 Avutometinib (PO; BIW 3 on/1 off) + Sotorasib (PO; Daily) Q28D
USOR 22201 X
USOR 22269 X
USOR 22329 X X Now available:

USOR 22329 Elacestrant + Capivasertib Q28D
USOR 23009 X X
USOR 23031 X
USOR 23049 X X
USOR 23055 X X X
USOR 23080 No longer available:

USOR 23080 Arm 2 ONC-392 Q21D
USOR 23201 X X
USOR 23292 X X No longer available:

USOR 23292 Part B1 ART0380 D2-4,9-11 + Gemcitabine D1,8 Q21D

 

Billing & HCPCS Codes

The April 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 April 2024 HCPCS quarterly updates, please visit CMS’s website.

For medications listed below that include a brand name, please refer to the NDC – HCPCS crosswalk table within the release notes for specific dispensable/NDC association.

The following products have not been released into the marketplace per FDB:

  • Fosaprepitant (focinvez)
  • Levothyroxine sodium (hikma) not therapeutically equivalent to j0650
  • Melphalan (hepzato)
  • Melphalan (apotex)
  • Natalizumab-sztn (tyruko)
  • Procenta
  • Tocilizumab-bavi (tofidence)

Updates

Medication HCPCS Codes
Aflibercept Intravitreal 8 mg/0.07 mL J0177 per

  • 0.001 mL
  • 1 mg
Avacincaptad pegol (PF) Intravitreal J2782 per 0.1 mg
Buprenorphine Subcutaneous ER Solution (Brixadi Monthly) J0577 per 1 mg
Buprenorphine Subcutaneous ER Solution (Brixadi Weekly) J0577 per 1 mg
Cantharidin Topical Solution 0.7 % J7354 per 1 application
Cipaglucosidase alfa-atga IV J1203 per 5 mg
Cyclophosphamide (ingenus) J9073 per 5 mg
Cyclophosphamide (sandoz) J9074 per 5 mg
Cyclophosphamide IV (not otherwise specified) J9075 per 5 mg
DaxibotulinumtoxinA-lanm IM (cosmetic) J0589 per

  • 0.5 mL
  • 1 units
Elranatamab-bcmm Subcutaneous J1323 per 5 mg
Human prothrombin complex concentrate (PCC)- lans IV J7165 per 1 units
Hydroxocobalamin IV J3424 per

  • 0.025gram
  • 25 mg
Levothyroxine (fresenius kabi) J0651 per 10 mcg
Levothyroxine (not otherwise specified) J0650 per 10 mcg
Lifileucel IV 7.5x 10exp9 to 72x10exp9 cell J9999 per 7.5x 10e9 viable cells
Methotrexate (accord) J9255 per 50 mg
Methylprednisolone Acetate IM J1010 per 1 mg
Methylprednisolone IV J2919 per 5 mg
Methylprednisolone (PF) Intratympanic J2919 per 5 mg
Methylprednisolone (PF) IV J2919 per 5 mg
Methylprednisolone Sodium Succinate (PF) IM J2919 per 5 mg
Methylprednisolone Sodium Succinate IM J2919 per 5 mg
Miglustat Oral J1202 per 65 mg
Motixafortide Subcutaneous J2277 per 0.25 mg
Pemetrexed (pemrydi rtu) J9324 per 10 mg
Pozelimab-bbfg IV J9376 per 1 mg
Pozelimab-bbfg Subcutaneous J9376 per 1 mg
Risperidone (rykindo) J2801 per 0.5 mg
Sodium Thiosulfate (hope) J0209 per

  • 0.1 grams
  • 100 mg
Somapacitan-beco Subcutaneous Pen Injector J3490 per

  • 5 mg
  • 10 mg
  • 15 mg
Talquetamab-tgvs Subcutaneous J3055 per 0.25 mg

NDC to HCPCS Crosswalk

Additions

Medication (Brand) HCPCS Code NDC
Cyclophosphamide (ingenus) J9073 per 5 mg 50742051902
50742052005
50742052110
68001056422
68001056528
70860021810
Cyclophosphamide (not otherwise specified) J9075 per 5 mg 10019095501
10019095601
10019095701
10019095616
10019095550
10019095711
10019093501
10019093525
10019093601
10019093650
10019093701
10019093710
10019093801
10019093825
10019093901
10019093950
10019094201
10019094210
10019094301
10019094325
10019094401
10019094450
10019094501
10019094510
70121123801
70121123901
70121124001
16714085901
16714085701
16714085801
72603032601
72603010401
68001044226
68001044327
68001044432
0860021805
70860021803
72572008301
72572008701
72572008501
51407074802
51407074905
51407075010
81298811201
81298811401
81298811001
39822025001
65219013120
65219013320
65219013520
39822025501
63323064916
63323088510
63323089010
Levothyroxine (fresenius kabi) J0651 per 10 mcg 63323089510
63323088514
63323088512
Levothyroxine (not otherwise specified) J0650 per 10 mcg 63323064810
63323064907
63323064710
63323064994
42023020101
42023020201
42023020301
66794064902
66794064702
66794064802
70860045110
70860045210
70860045310
24201000201
25021046810
25021046910
25021047010
63323012108
63323012110
63323012250
61703040841
00703367101
00703367501
00703367801
67457048040
16729027735
Methotrexate J9255 per 50 mg 16729027703
16729027730
61703040825
63323012259
00703367881
00143983001
00143951901
00143951910
00143936701
61703012440
00009027401
00009028002
00009028003
00009028051
00009028052
00009030602
00009030612
00009307301
Methylprednisolone Acetate IM J1010 per 1 mg 00009307303
00009307322
00009307323
00009347501
00009347503
00781351675
25021082005
25021082010
25021082105
42023023901
42023024001
50090043600
50090055600
50090209800
50090589400
55150031301
55150031401
60219157301
60219157305
60219157401
60219157405
69852011510
69852091610
70121155201
70121155205
70121157301
70121157305
70121157401
70121157405
71266107501
76420008101
63323025803
63323025503
63323026530
00009003932
00009004726
00009003928
00009004722
00009000302
00009001820
00009003930
00009004725
00009003933
00009004727
Methylprednisolone (PF) Intratympanic J2919 per 5 mg 00009069801
00009075801
70121100005
70121100105
70121100001
70121100101
00009069802
00009004704
00009004703
00009003906
00009003905
55154394005
55154394105
00143985101
00143985001
00009085001
43598012725
43598012745
43598012925
43598012901
43598012811
43598013074
50090027100
50090027101
00143975325
00143975301
00143975425
00143975401
00009000302
00009001820
00009003905
00009003906
00009003928
00009003930
00009003932
00009003933
00009004703
00009004704
00009004722
00009004725
00009004726
00009004727
00009069801
00009069802
00009075801
00009085001
00143975301
Methylprednisolone IV J2919 per 5 mg 00143975325
00143975401
00143975425
00143985001
00143985101
43598012725
43598012745
43598012811
43598012901
43598012925
43598013074
50090027100
50090027101
55154394005
55154394105
63323025503
63323025803
63323026530
0121100001
70121100005
70121100101
70121100105
Pemetrexed (pemrydi rtu) J9324 per 10 mg 70121246101
70121245301
Risperidone (rykindo) J2801 per 0.5 mg 72526020201
72526010211
72526020301
72526010311
72526020401
72526010411
Sodium Thiosulfate IV J0209 per

  • 0.1 grams
  • 100 mg
 60267070550