July 1, 2024

Updated July 1, 2024.

Effective April 1, HCPCS J1020, J1030, and J1040 have been deleted from the HCPCS code set, which is managed by CMS. A new code, HCPCS J1010, was added to replace these deleted codes. (J1010-Injection, methylprednisolone acetate, 1 mg). If 0.5mL of 30mg/mL of methylprednisolone acetate is injected, that would be represented by 15 units of HCPCS J1010. 

APMA is aware of inappropriate denials involving J1010 such as those reported in the comment section below. At the moment, we think multiple payers inappropriately excluded podiatrists as eligible providers for this service when programming the new code. APMA is in the process of collecting de-identified EOBs from members who have experienced this problem to help demonstrate the error to payers.  

Novitas and First Coast Service Operations (FCSO) have confirmed that they have added the provider type (30) for podiatrist recently to their claims processing systems for J1010, and acknowledged that the denied claims were most likely processed before that correction. The recommendation for podiatrists in Novitas and FCSO who have experienced inappropriate denials related to this code should resubmit those claims for processing. APMA is working on resolving this issue with other MACs and will provide updates as they are available. 

In the meantime, individual providers who are experiencing this inappropriate denial are encouraged to communicate with the payer in question to explain their error. Hearing the same messaging from multiple sources will hopefully help the effort. 

Reference: https://www.cms.gov/files/document/2023-hcpcs-application-summary-quarter-4-2023-drugs-and-biologicals-posted-01/26/2024-updated-03/04.pdf.  

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