Important Updates to HCPCS Codes for Methylprednisolone and Methotrexate (Effective April 1, 2024) : J1010 CPT update

The Centers for Medicare & Medicaid Services (CMS) has updated the Healthcare Common Procedure Coding System (HCPCS) for certain injectable medications, including methylprednisolone and methotrexate. These changes apply to claims with service dates on or after April 1, 2024.

Here’s a summary of the revisions:

• Methylprednisolone: Codes for specific dosages of methylprednisolone acetate (20mg, 40mg, 80mg) have been discontinued.
• Methotrexate: The code for methotrexate sodium (5mg) is no longer valid.

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For Methotrexate Billing:

• Use either J9260 (Injection, methotrexate sodium, 50 mg) or J9255 (Injection, methotrexate (Accord), not therapeutically equivalent to J9260, 50 mg).
• Be sure to consider the unit change (from 5mg to 50mg) when selecting the appropriate code.

Simplified Coding for Methylprednisolone Acetate Injections : J1010 CPT update

There’s a new HCPCS code, J1010, for injectable methylprednisolone acetate. This replaces the previous system of three separate codes based on dosage (J1020, J1030, and J1040).

• J1020 (Injection, methylprednisolone acetate, 20 mg)
• J1030 (Injection, methylprednisolone acetate, 40 mg)
• J1040 (Injection, methylprednisolone acetate, 80 mg)

How it works:

• J1010 CPT represents 1 milligram (mg) of methylprednisolone acetate.
• To report the dosage, multiply J1010 by the number of milligrams injected.
• For example, an 80mg injection would be coded as J1010 x 80 units.

Important note: J1010 CPT update

While J1010 CPT simplifies coding, you’ll still need to include the National Drug Code (NDC) number on your claim. This helps insurance carriers identify the specific strength/concentration used (previously indicated by the discontinued codes).

Important Changes to Methotrexate Coding for Medicare Billing (Effective April 1, 2024)

There are key updates to how providers should bill Medicare for methotrexate:

• Discontinued Code: HCPCS code J9250 (Methotrexate sodium, 5 mg) is no longer valid.
• Revised Code: The descriptor for HCPCS code J9260 has been updated to clarify it’s for an injection: J9260 (Injection, methotrexate sodium, 50 mg).

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Choosing the Right Code:

• Unit Change: Be aware of the unit change from 5mg (J9250) to 50mg (J9255 and J9260).
• Manufacturer: Identify the methotrexate manufacturer used.
  • J9260: Use this code for any manufacturer other than Accord.
  • J9255: Use this code specifically for Accord’s methotrexate (not therapeutically equivalent to others).

Additional Resources:

• If unsure about coding, contact your Medicare Administrative Contractor (MAC) for guidance.

Importance of Accurate Coding:

• Understanding these updates is crucial for proper reimbursement, reduced claim denials, and maintaining quality patient care.
• The American College of Rheumatology (ACR) is working with CMS to determine further recommendations for rheumatologists specifically. Stay tuned for future updates from the ACR.