CommercialBilling CodesHigh impact
HCPCS replacement codes established, effective July 1, 2026
BCBS Michigan·MI · Oncology, Rheumatology, Ophthalmology +2 more·Coding
Effective date
Jul 1, 2026
We identified it
Aug 26, 2026
Summary
Effective July 1, 2026, CMS has established five new HCPCS procedure codes to replace generic placeholder codes (C9399, J3490, J3590, J9999) for five specialty biosimilar drugs: YARTEMLEA, Starjemza, Jubereq/Osvyrti, Enoby/Xtrenbo, and Eydenzelt. All services on or after July 1, 2026 must use the new specific codes (J1289, Q5164, Q5166, Q5167, Q5170). Prior authorization is required for all codes unless the member's group has opted out of the Medical Benefit Drug program.
Action Required
By June 30, 2026: Billing team must update billing software and claim submission systems to enforce the following code replacements effective July 1, 2026: (1) Replace C9399, J3490, J3590, J9999 with J1289 for YARTEMLEA (narsoplimab-wuug); (2) Replace C9399, J3490, J3590, J9999 with Q5164 for Starjemza (ustekinumab-hmny) and add site-of-care prior authorization requirement; (3) Replace C9399, J3490, J3590, J9999 with Q5166 for Jubereq/Osvyrti (denosumab-desu) and add site-of-care prior authorization requirement; (4) Replace C9399, J3490, J3590, J9999 with Q5167 for Enoby/Xtrenbo (denosumab-qbde) and add site-of-care prior authorization requirement; (5) Replace C9399, J3490, J3590, J9999 with Q5170 for Eydenzelt (aflibercept-boav). For all new codes, billing team must implement prior authorization requirements through the Medical Benefit Drug program for all groups UNLESS the group has opted out—verify each group's opt-in/out status on the Prior Authorization Opt-In/Out Group list before submitting claims. Continue using old codes (C9399, J3490, J3590, J9999) through June 30, 2026. Train providers and clinical staff on the new codes and emphasize that claims submitted with old codes after July 1, 2026 will be denied. Update internal fee schedules and charge capture systems with new code mappings.