CMS issued its July 2025 update to the Ambulatory Surgical Center (ASC) Payment System, which includes the addition of new HCPCS codes and revisions to the coding for drugs, biologicals, and radiopharmaceuticals.
New HCPCS Codes
CMS has established 12 new HCPCS codes for drugs, biologicals, and radiopharmaceuticals, which are now separately payable under the ASC payment system as of July 1, 2025. The new codes are:
- C9174 (Injection, datopotamab deruxtecan-dlnk, 1 mg)
- C9175 (Injection, treosulfan, 50 mg)
- J1326 (Injection, zolbetuximab-clzb, 2 mg)
- J7172 (Injection, marstacimab-hncq, 0.5 mg)
- J9174 (Injection, docetaxel (beizray), 1 mg)
- J9220 (Injection, indigotindisulfonate sodium, 1 mg)
- J9276 (Injection, zanidatamab-hrii, 2 mg)
- J9289 (Injection, nivolumab, 2 mg and hyaluronidase-nvhy)
- J9342 (Injection, thiotepa, not otherwise specified, 1 mg)
- J9382 (Injection, zenocutuzumab-zbco, 1 mg)
- Q5099 (Injection, ustekinumab-stba (steqeyma), biosimilar, 1 mg)
- Q5100 (Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg)
The ASC payment indicator (PI) for these new codes is K2, which signifies that drugs, biologicals, and radiopharmaceuticals are paid separately when provided as an integral part of a surgical procedure on the ASC list, with payment based on the Outpatient Prospective Payment System (OPPS) rate.
Reassigned ASC Payment Indicators
CMS has also reassigned the ASC PIs for several existing HCPCS codes for drugs, biologicals, and radiopharmaceuticals.
The following codes have been reassigned from PI K5 to PI K2 as of July 1. This change means they are now separately payable.
- Q5136 (Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg)
- Q5146 (Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg)
- Q9998 (Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg)
The following codes have been reassigned from PI K2 to PI K5 as of July 1. This change indicates that these codes are no longer separately payable, as no payment is made for items, codes, and services where pricing information and claims data are unavailable.
- J1726 (Injection, hydroxyprogesterone caproate, [Makena], 10 mg)
- J9057 (Injection, copanlisib, 1 mg)
- J9262 (Injection, omacetaxine mepesuccinate, 0.01 mg)
