The Centers for Medicare & Medicaid Services (CMS) has updated its HCPCS (Common Procedural Coding System) Level II coding procedures to allow for shorter and more frequent HCPCS code cycles.
HCPCS or Common Procedure Coding System for Health Care represents medical procedures, supplies, products, and services and is used to help Medicare and other insurance companies process health insurance claims.
In these updates, there is a significant change in comparison to the previous framework, in which there was only one submission deadline and coding cycle for each calendar year.
In addition, these updates are part of CMS’s “innovation relief” initiative and provide manufacturers and other stakeholders the opportunity to take advantage of more frequent coding filing opportunities.
In a second-quarter update, 23 codes are added to these categories, six codes are revised and 12 codes are discontinued.
Let’s have a look at HCPCS level II Code Updates;
HCPCS Level II Code Updates
Here you can see a list of newly added codes;
- A9592 Copper cu-64, dotatate, diagnostic, 1 millicurie
- C9074 Injection, lumasiran, 0.5 mg
- C9777 Esophageal mucosal integrity testing by electrical impedance, transoral (list separately in addition to code for primary procedure)
- G2020 High-intensity clinical services related to primary engagement and coverage of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes). CMS advises that G2020 services should be provided and billed at least one day before all other services covered by the home visit fee are reimbursed.
- G2172 Payment for services associated with highly comprehensive and fully coordinated opioid use disorder (OUD) treatment services provided as part of a demonstration project, inclusive.
- J1427 Injection, viltolarsen, 10 mg
- J1554 Injection, immune globulin (asceniv), 500 mg
- J7402 Mometasone furoate sinus implant, (sinuva), 10 micrograms
- J9037 Injection, belantamab mafodotin-blmf, 0.5 mg
- J9349 Injection, tafasitamab-cxix, 2 mg
- K1013 Enema tube, any type, replacement only, each
- K1014 Adduct, endoskeletal knee corrugator system, 4-bar attachment or multiaxial, fluid swing system and positioning phase control
- K1015 Foot, adductor positioning device, customizable
- K1016 Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve.
- K1017 Monthly supplies for using a k1016 coded device
- K1018 External upper extremity peripheral wrist nerve tremor stimulator
- K1019 Monthly supplies for using a k1018 coded device.
- K1020 Non-invasive vagus nerve stimulator
- M0245 Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post-administration monitoring
- Q0245 Injection, bamlanivimab and etesevimab, 2100 mg
- Q2053 Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
- S1091 Stent, non-coronary, temporary, with a delivery system (propel)
These codes, such as K1013, K1014, K1015, K1016, K1017, K1018, K1019, and K1020, were the result of stakeholder requests received at the HCPCS PBC public meeting. Code K1019 replaces A4595 for reporting wrist connector component replacements.
Several code descriptor changes are updated in April 2021, which are listed here;
- C9761 Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for controlled vacuum aspiration of the kidney, collection system, ureter, bladder and urethra, if valid.
- G9868 Remote, asynchronous image acquisition and analysis for dermatologic and/or ophthalmologic evaluation, for use only in Medicare-approved cmmi model, less than 10 min.
- G9869 Remote, asynchronous image acquisition, and analysis for dermatologic and/or ophthalmologic evaluation, for use only in Medicare-approved CMMI model, for 10-20 minutes.
- G9870 Remote, asynchronous image acquisition and analysis for dermatologic and/or ophthalmologic evaluation, for use only in Medicare-approved cmmi model, for more than 20 minutes.
- J7321 Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose
Deleted HCPCS Level II Codes
On April 1, 21, the following codes are discontinued:
- C9068 Copper cu-64, dotatate, diagnostic, 1 millicurie
- C9069 Injection, belantamab mafodotin-blmf, 0.5 mg
- C9070 Injection, tafasitamab-cxix, 2 mg
- C9071 Injection, viltolarsen, 10 mg
- C9072 Injection, immune globulin (asceniv), 500 mg
- C9073 Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
- C9122 Mometasone furoate sinus implant, 10 micrograms (sinuva)
- J7333 Hyaluronan or derivative, visco-3, for intra-articular injection, per dose
- J7401 Mometasone furoate sinus implant, 10 micrograms
- K1010 Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each
- K1011 Activation device for intraurethral drainage device with valve, replacement only, each
K1012 Charger and base station for intraurethral activation device replacement only.
Each year HCPCS coding changes. This is why healthcare providers should ensure that their coders are aware of these changing billing and coding standards or not.
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