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HCPCS Level II Quarterly Updates

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.

Revised Codes

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.

Need a professional and skilled coder? Partner with Med-Miles LLC. Our trained coders and billing specialists fulfill all your coding needs and get you paid faster for the services provided. Call our experts at +1 888-598-9181.

CMS Price Transparency Audit- What Hospitals Need To Know?

Growing healthcare costs have long been a burden on the United States. Even consumers, employers, and providers bear this burden. But, besides all this, the healthcare charges or fees of services are still not clear or comparable.

Due to the increase in the regulatory requirements and primary focus on improving overall price transparency of hospital charges and out-of-pocket costs for patients, CMS and different private insurance companies had pushed the healthcare providers to show all the information that includes the cost and values of all the services.

Yes, we talk about the Price Transparency final rule. CMS had done their price transparency audit in January 2021, in which hospitals and health systems are required to meet the terms of the Hospital Price Transparency requirements.

For hospitals that didn’t do compliance, CMS takes a corrective action plan or imposes a Civil Monetary penalty of $300 per day and publicizes their penalty on the CMS website.

Background History

In 2010, the Affordable Care Act first introduced the concept of publicizing standard charges for items and services provided by a hospital. From then on, the federal government has taken a harder decision on what hospitals would have to publish, where they would be published, and how compliance would be checked and imposed.

As healthcare costs have been increased that forced different entities to establish policies and strategies for cost control. In June 2019, the president signed their first order directed to the Department of Health and Human Services to develop rules which require hospitals to publish consumer-friendly format prices. Which reflects what people actually pay for the services.

What Is Required?

Each hospital that is operating in the United States is required to provide clear and accessible pricing information online about the items and services they provide in two ways:

Comprehensive machine-readable file with all items and services that discloses five types of standard charges including gross charges includes descriptions of each item or service; unidentified minimum and maximum negotiated charges and discounted cash price.
Display of shoppable services in a consumer-friendly format (which can also be scheduled in advance). An online patient-facing price transparency tool would also satisfy this requirement.

With this clear information, it is easy for consumers to shop and compare all prices of different hospitals and estimate the cost of care before going to any hospital.

By giving all this information CMS will monitor compliance by reviewing all the complaints that are submitted by individuals and different entities. After checking such complaints if CMS finds any hospital to be non-compliant, then CMS would take additional actions as said above.

Necessary Requirements

Following are the necessary requirements that every hospital should know. Let’s have a look!

Items and Services

It includes all items and services such as individual items and services and all the services packages that hospitals provide to a patient in connection or outpatient department visit.

Standard Charges

CMS recognizes that hospitals may not have standard charges for an item or service, it depends on circumstances and conditions. For this reason, CMS has defined the standard charges that are listed below:

Gross Charges

A charge for an individual item or service that is reflected in the hospital charges. This fee does not include any discounts.

Payer-Specific Negotiated Charges

This is the charge that the hospital has negotiated with the third-party payer for the item or service. It does not include the amount ultimately paid by the insurer or patient for the item or service, but only the negotiated base rate. Also, this rate does not include non-negotiated payment rates like a fee for service Medicare or Medicaid

Discounted Cash Price

It is a discounted rate that the hospital charges individuals who pay cash or cash equivalents for an individual unit, service, or package of services.

De-Identified Minimum and Maximum Negotiated Charge

These charges include the lowest or highest charges that hospitals have negotiated with all third-party payers for an item or service.

Shoppable Services

When a hospital provides these services, CMS has identified 70 shoppable services for which the appropriate standard fee must be charged. The hospital must select an additional 230 shoppable services based on the prior year’s utilization or rates for the services.

For questions related to CMS’ final Price Transparency Rule, or if you need help evaluating how your organization will comply with the Rule, contact one of our specialists at +1 888-598-9181