Update to Allowable Specialized Services

July 8, 2021

Effective for dates of service on or after July 1, 2021, the list of specialized services that can be billed on an outpatient claim, even when provided on an inpatient basis, is updated. Existing policy currently in place for other allowable specialized services shall remain in place.

Blood Factors HCPCS Code Effective Dates Notes
Blood Factor X J7175 July 1, 2021 N/A
Blood factor Von Willebrand J7179 July 1, 2021 N/A
Blood factor XIII
Antihemophilic factor
J7181 July 1, 2021 Replaces C9134
Blood factor VIII/Novoeight J7182 July 1, 2021 N/A
Blood factor VIII J7204, J7205,
J7211, J7207,
J7208, J7209,
J7210
July 1, 2021 N/A
Blood Factor VIII/Obizur J7188 July 1, 2021 N/A
Blood factor VIIa/SevenFact J7212 July 1, 2021 Previously J7199
Blood factor IX/Rixubis/
Alprolix/Idelvion/Rebinyn
J7200, J7201,
J7202, J7203
July 1, 2021 N/A
Alprolix J7201 July 1, 2021 Previously J7199
Onasemnogen
abeparvovec-xioi (Zolgensma®)
J3399 July 1, 2021 Separate CCS authorization is required for outpatient administration