Make sure you’re using the latest code files for your Medicare claims.
A second quarter update to the HCPCS Level II code set used for reporting products, supplies, and services adds 23 codes. Additionally, six codes are revised and 12 are discontinued, effective April 1, 2021. There are also two codes with changes to Medicare coverage.
New HCPCS Level II Codes
The Centers for Medicare & Medicaid Services (CMS) posts quarterly updates of the HCPCS Level II code system on their website. The public use files are available for download. Following are just the changes.
|Code||Long Descriptor||OPPS SI||APC|
|A9592||Copper cu-64, dotatate, diagnostic, 1 millicurie||G||9383|
|C9074||Injection, lumasiran, 0.5 mg||G||9407|
|C9777||Esophageal mucosal integrity testing by electrical impedance, transoral (list separately in addition to code for primary procedure)||N|
|G2020||Services for high intensity clinical services associated with the initial engagement and outreach of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes)|
|G2172||All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project|
|J1427||Injection, viltolarsen, 10 mg||G||9386|
|J1554||Injection, immune globulin (asceniv), 500 mg||G||9392|
|J7402||Mometasone furoate sinus implant, (sinuva), 10 micrograms||G||9346|
|J9037||Injection, belantamab mafodontin-blmf, 0.5 mg||G||9384|
|J9349||Injection, tafasitamab-cxix, 2 mg||G||9385|
|K1013||Enema tube, any type, replacement only, each|
|K1014||Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control|
|K1015||Foot, adductus positioning device, adjustable|
|K1016||Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve|
|K1017||Monthly supplies for use of device coded at k1016|
|K1018||External upper limb tremor stimulator of the peripheral nerves of the wrist|
|K1019||Monthly supplies for use of device coded at k1018|
|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 delivery system (propel)|
Background Information on New Codes
Some of these new codes are a result of stakeholder requests at CMS’ HCPCS Public Meeting, Dec. 21-22, 2020, such as:
K1013 identifies both Applied Medical Technology, Inc.’s MiniACE — a low profile, percutaneous antegrade continence enema (ACE) device and Cook Medical’s Chait Access Adapter with Connection Tube.
K1015 identifies the UNFO-S orthopedic device worn below the ankle that “offers improved outcomes for metatarsus adductus/varus over traditional serial casting,” according to requester Magic Orthopedics Ltd.
K1014 identifies the addition to lower extremity, endoskeletal system, above knee disarticulation, 4 bar linkage, with hydraulic swing and stance phase control such as the ALLUX microprocessor-controlled knee, which includes a proprietary Safety Lock. This device is intended for use by amputees who are missing their leg through knee joint or higher.
K1016 identifies the Monarch external Trigeminal Nerve Stimulation (eTNS) System. This device is used for the treatment of attention deficit hyperactivity disorder (ADHD) in children ages 7 through 12 years who are currently not taking prescription ADHD medications. The device is intended to be used in the home while the child is sleeping. K1017 identifies the Monarch NS-2 Electric Patch Pouch — a seven-day refill of disposable electric patches for the eTNS System. K1017 replaces A4595 Electrical stimulator supplies, 2 lead, per month, (e.g., for tens, nmes).
K1018 identifies the Cala Trio nerve stimulating device. The Cala Trio device consists of a rechargeable stimulator and recharging base station and a wrist-worn connector. The device is intended for home use in patients to treat essential tremors. K1019 replaces A4595 for reporting replacement components of the wrist-worn connector. According to Cala Health, the wrist-worn connector is good for 90 days.
K1020 describes a non-invasive vagus nerve stimulator (GammaCore Sapphire D) that provides therapy to prevent and acutely treat cluster headaches in adult patients.
Revised HCPCS Level II Codes
Also in the April 2021 update are several code descriptor changes, listed here:
|C9761*||Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if applicable|
|G9868||Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes|
|G9869||Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes|
|G9870||Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes|
|J7321||Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose|
Discontinued HCPCS Level II Codes
The following codes are discontinued effective April 1, 2021:
|C9068||Copper cu-64, dotatate, diagnostic, 1 millicurie|
|C9069||Injection, belantamab mafodontin-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|
April Update to OPPS
In the hospital Outpatient Prospective Payment System (OPPS) April 2021 update, CMS is establishing the new HCPCS Level II code C9776 Intraoperative near-infrared fluorescence imaging of major extra-hepatic bile duct(s) (e.g., cystic duct, common bile duct and common hepatic duct) with intravenous administration of indocyanine green (icg) (list separately in addition to code for primary procedure). The administration of the intravenous indocyanine green for the visualization of major extrahepatic biliary ducts, reported with C9776, is associated with laparoscopy cholecystectomy. The OPPS status indicator is N.
OPPS Status Indicator Corrections
CMS has issued status indicator corrections for HCPCS Level II codes G2061-G2063 and CPT® codes 98970-98972. The three G codes were deleted Dec. 31, 2020, replaced by the three CPT® codes. Effective Jan. 1, 2021, status indicator D is assigned to G2061-G2063 and status indicator A (paid under a fee schedule or payment system other than the OPPS) is assigned to 98970-98972.
Likewise, G2010 and G2012 were incorrectly assigned to status indicator A in the January 2021 Integrated Outpatient Code Editor (I/OCE). These codes were replaced with G2250 and G2251, effective Jan. 1, 2021, for certain non-physician practitioners, including rehab therapists, and are assigned to status indicator B under OPPS to indicate that other more appropriate codes should be reported.
Visit complexity code G2211 was also assigned to the wrong status indicator in the January 2021 I/OCE. In the April I/OCE, this is corrected, effective Jan. 1, 2021, to status indicator B to indicate that it shouldn’t be payable under OPPS because it is an add-on code to existing evaluation and management codes that are assigned to status indicator B.
Q5122 Injection, pegfilgrastim-apgf, biosimilar, (nyvepria), 0.5 mg from Jan. 1, 2021, through March 31, 2021, is retroactively changed from E2 to K in the April I/OCE.
Also note that the OPPS status indicator for CPT® code 0632T Percutaneous transcatheter ultrasound ablation of nerves innervating the pulmonary arteries, including right heart catheterization, pulmonary artery angiography, and all image guidance is changed from E1 (not payable by Medicare) to J1 (hospital Part B services paid through a comprehensive APC) and is assigned to APC 5194, effective April 1, 2021.
Lastly, the status indicator for CPT® code 81599 is E1 and the status indicator for 81529 is A, effective Jan. 1, 2021.
The list of drugs and biologicals with correct payment rates will be available April 1 here. “Providers may resubmit claims that were impacted by adjustments to previous quarter’s payment files,” CMS states in MLN Matters® article MM12175.