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April 2018 HCPCS Quarterly Update: Policy Updates

September 14, 2018

Effective for dates of service on or after April 1, 2018, the following HCPCS codes are Medi-Cal benefits:

HCPCS Code Description
C9462 Injection, delafloxacin, 1 mg
C9463 Injection, aprepitant, 1 mg
C9464 Injection, rolapitant, 0.5 mg
C9466 Injection, benralizumab, 1 mg
C9749 Repair of nasal vestibular lateral wall stenosis with implant(s)
Q2041 Axicabtagene ciloleucel, up to 200 million autologous anti-CD19 CAR T Cells, including leukapheresis and dose preparation procedures, per infusion
Q5103 Injection, infliximab-dyyb, biosimilar, (Inflectra), 10 mg
Q5104 Injection, infliximab-abda, biosimilar, (Renflexis), 10 mg

In addition, codes Q5103 and Q5104 replace terminated code Q5102 (injection, infliximab, biosimilar, 10 mg).