Retro Physician Drug Rate Updates: Effective July 2024 – June 2025, CR 133663
The Department updated multiple physician drug codes retroactively due to a rate update from the Centers for Medicare & Medicaid Services (CMS). These new rates were implemented on July 30, 2025.
See the table below for the revised rates and their effective dates.
|
Procedure Code |
Start Date |
End Date |
Revised Rate |
Original Rate |
|
Q5126 |
7/1/2024 |
9/30/2024 |
$52.35 |
$52.42 |
|
J9331 |
7/1/2024 |
9/30/2024 |
$78.26 |
$113.74 |
|
J9331 |
10/1/2024 |
12/31/2024 |
$78.57 |
$114.21 |
|
J9331 |
1/1/2025 |
3/31/2025 |
$80.81 |
$117.45 |
|
J9331 |
4/1/2025 |
6/30/2025 |
$80.93 |
$117.63 |
|
J7323 |
4/1/2025 |
6/30/2025 |
$126.41 |
$128.71 |
Adjustments for affected claims:
We will reprocess claims submitted with charges at or above the rates indicated in the table above. No provider action is required.
For questions, please contact your Provider Relations Specialist.