New HCPCS Code - Revefenacin (Yupelri®) - J7677

Joint DME MAC Publication

Effective for dates of service on or after July 1, 2019, a new HCPCS code is available for revefenacin (Yupelri^®). The new HCPCS code is J7677 (REVEFENACIN INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, 1 MICROGRAM). Claims with dates of service before July 1, 2019 must be billed using HCPCS code J7699 (NOC DRUGS, INHALATION SOLUTION ADMINISTERED THROUGH DME).

Revefenacin is a lung-specific, long-acting muscarinic antagonist (LAMA), also referred to as an anticholinergic. Revefenacin received Food & Drug Administration (FDA) approval on November 9, 2018 with an indication for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD). The recommended dose of revefenacin inhalation solution is administered once daily via a standard jet nebulizer. Revefenacin is supplied in 175 mcg/3 ml. unit-dose vial (UOS per month = 5,250). To bill a 3-month supply, suppliers must submit the total units of service split between two claim lines.

When claims are billed in National Council for Prescription Drug Programs (NCPDP) format using National Drug Codes (NDCs), different instructions may apply. Refer to the NCPDP Companion Document available through the CMS website. The NDC numbers for revefenacin are:

• 49502-0806-32 (Single 3 ml vial (175mcg/3ml))
• 49502-0806-93 (Thirty (30) 3 ml vials (175mcg/3ml))

The DME MACs have responded to a valid LCD reconsideration request from Mylan Pharmaceuticals on February 15, 2019. The request proposes the addition of revefenacin to the Nebulizer LCD. A decision from the DME MACs regarding revefenacin is pending. Until HCPCS code J7677 is added to the Nebulizer Local Coverage Determination (LCD L33370), claims submitted to the DME MACs will be reviewed for individual adjudication.

Suppliers are encouraged to read the entire Nebulizers LCD (L33370) and related Policy Articles (A52466 and A55426) for additional coding, coverage, and documentation requirements.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) contractor Contact Center.