Methylprednisolone & Methotrexate: Codes & Billing Updated

On April 1, the Centers for Medicare & Medicaid Services (CMS) released its first quarter Healthcare Common Procedure Coding System (HCPCS) update with revisions for methylprednisolone and methotrexate. All HCPCS code changes are effective and should be used for claims with dates of services on or after April 1, 2024. The procedure codes described below have been revised and/or discontinued effective April 1, 2024.

Methylprednisolone

There is a single, new HCPCS code, J1010, for methylprednisolone acetate, injection, 1 mg. This was previously reported with three HCPCS codes:

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

J1010 now represents “1 mg,” so each milligram reported will be as a unit. For example, if the provider injects methylprednisolone 80 mg, this will be reported as J1010 x 80 units. Also, the National Drug Code (NDC) number will need to be reported on the claim to alert the insurance carrier as to which strength/concentration was used (J1020, J1030, J1040).

Methotrexate

HCPCS code J9250 (Methotrexate sodium, 5 mg) has been deleted. The word “injection” has been added to the descriptor for HCPCS code J9260, so it now reads: J9260 (Injection, methotrexate sodium, 50 mg).

When billing Medicare for methotrexate, providers must either use J9255 (Injection, methotrexate (Accord), not therapeutically equivalent to J9260, 50 mg) or J9260. To determine which code to use, doctors must first note the unit change from 5 mg (for J9250) to 50 mg (for J9255 and J9260). Second, they must verify which methotrexate manufacturer is being used and utilize the appropriate J code; for example, Accord’s methotrexate is assigned to J9255, effective Jan. 1, 2024. This follows a protocol that the CMS has established with other codes, creating separate codes for each manufacturer’s non-therapeutically equivalent version of the drug.

If providers continue to have issues coding for methotrexate, they should reach out to their Medicare Administrative Contractor for guidance.

Medical codes are an integral part of revenue cycle management, making it important to understand the adjustments and modifications to ensure proper reimbursement, reduce denials and quality patient care. The ACR is currently working with the CMS to determine how rheumatologists should bill Medicare for these drugs accurately. We will continue to update the ACR membership with new details on this issue as we receive them.

For questions on accurate coding and wastage for these revised drug codes, contact Antanya Chung at [email protected]; for information on our advocacy updates, contact Colby Tiner at [email protected].