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Tag Archives: HCPCS

New HCPCS Level II Codes for July

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And one new code with an effective date retroactive to April 1. The results of the Centers for Medicare & Medicaid Services’ (CMS’) first quarter 2023 drug and biological HCPCS Level II code application review cycle is now available. CMS accepted 36 applications for new drugs and biologicals and approved 23. The new codes established […]

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October Brings HCPCS Level II Code Changes

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Dozens of additions, deletions, and revisions are effective Oct. 1, 2022. The October 2022 update to the HCPCS Level II code file from the Centers for Medicare & Medicaid Services (CMS) includes more than 40 changes, and most of them are new codes. The changes are effective Oct. 1, 2022, with a few important exceptions. […]

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CMS Updates HCPCS Level II for Q2

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Coding highlights and other insight. The HCPCS Level II code set used to report medical services and supplies will include 37 new codes effective April 1, 2022. Also in the second quarter update, five codes will be deleted and one modifier’s description will be revised. Lay Terms for New Codes Among the new codes being […]

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Learn More About 2022 HCPCS Level II Code Changes

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In first quarter 2022, the HCPCS Level II code set will get a refresh with several new, revised, and deleted codes. According to the Centers for Medicare & Medicaid Services (CMS), there are: 155 new codes, 63 revised codes, and 48 deleted codes. Medical coders and billers: Familiarize yourself now with these code changes so […]

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April Updates Bring HCPCS Changes

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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 […]

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HCPCS Level II Code Changes in Effect July 1

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The Centers for Medicare & Medicaid Services (CMS) released on May 13 the July 2020 quarterly update to the HCPCS Level II file. There are 61 added codes to describe healthcare equipment and supplies not identified by CPT® codes, as well as nine deleted codes and three revised codes. The July update to the HCPCS […]

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HCPCS Codes Changes effective from October 1, 2019

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The HCPCS code set is updated quarterly. CR 11422 informs MACs and providers of the latest updates to specific drug/biological HCPCS codes. The October 2019 quarterly HCPCS file includes forty-four (44) new HCPCS codes. Effective for claims with dates of service on or after October 1, 2019.

1) J0121
a. Short Descriptor: Inj., omadacycline, 1 mg
b. Long Descriptor: Injection, omadacycline, 1 mg
c. Type of Service (TOS): 1,P

2) J0122
a. Short Descriptor: Inj., eravacycline, 1 mg
b. Long Descriptor: Injection, eravacycline, 1 mg
c. TOS: 1,P

3) J0222
a. Short Descriptor: Inj., patisiran, 0.1 mg
b. Long Descriptor: Injection, Patisiran, 0.1 mg
c. TOS: 1

4) J0291
a. Short Descriptor: Inj., plazomicin, 5 mg
b. Long Descriptor: Injection, plazomicin, 5 mg
c. TOS: 1

5) J0593
a. Short Descriptor: Inj., lanadelumab-flyo, 1 mg
b. Long Descriptor: Injection, lanadelumab-flyo, 1 mg (code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered)
c. TOS: 1

6) J1096
a. Short Descriptor: Dexametha opth insert 0.1 mg
b. Long Descriptor: Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
c. TOS: 1

7) J1097
a. Short Descriptor: Phenylep ketorolac opth soln
b. Long Descriptor: Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml
c. TOS: 1

8) J1303
a. Short Descriptor: Inj., ravulizumab-cwvz 10 mg
b. Long Descriptor: Injection, ravulizumab-cwvz, 10 mg
c. TOS: 1,P

9) J1943
a. Short Descriptor: Inj., aristada initio, 1 mg
b. Long Descriptor: Injection, aripiprazole lauroxil, (aristada initio), 1 mg
c. TOS: 1

10) J1944
a. Short Descriptor: Inj., aripirazole lauroxil 1 mg
b. Long Descriptor: Injection, aripiprazole lauroxil, (aristada), 1 mg
c. TOS: 1

11) J2798
a. Short Descriptor: Inj., perseris, 0.5 mg
b. Long Descriptor: Injection, risperidone, (perseris), 0.5 mg
c. TOS: 1,P

12) J3031
a. Short Descriptor: Inj., fremanezumab-vfrm 1 mg
b. Long Descriptor: Injection, fremanezumab-vfrm, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered)
c. TOS: 1, P

13) J3111
a. Short Descriptor: Inj. romosozumab-aqqg 1 mg
b. Long descriptor: Injection, romosozumab-aqqg, 1 mg
c. TOS: 1

14) J7314
a. Short Descriptor: Inj., yutiq, 0.01 mg
b. Long Descriptor: Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg
c. TOS: 1

15) J7331
a. Short Descriptor: Synojoynt, inj., 1 mg
b. Long Descriptor: Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg
c. TOS: 1

16) J7332
a. Short Descriptor: Inj., triluron, 1 mg
b. Long Descriptor: Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg
c. TOS: 1

17) J7401
a. Short Descriptor: Mometasone furoate sinus imp
b. Long Descriptor: Mometasone furoate sinus implant, 10 micrograms
c. TOS: 1

18) J9118
a. a. Short Descriptor: Inj. Calaspargase pegol-mknl
b. b. Long Descriptor: Injection, calaspargase pegol-mknl, 10 units
c. c. TOS: 1,P

19) J9119
a. Short Descriptor: Inj., cemiplimab-rwlc, 1 mg
b. Long Descriptor: Injection, cemiplimab-rwlc, 1 mg
c. TOS: 1

20) J9204
a. Short Descriptor: Inj, mogamulizumab-kpkc, 1 mg
b. Long Descriptor: Injection, mogamulizumab-kpkc, 1 mg
c. TOS: 1,P

21) J9210
a. Short Descriptor: Inj., emapalumab-lzsg, 1 mg
b. Long Descriptor: Injection, emapalumab-lzsg, 1 mg
c. TOS: 1 

22) J9269
a. Short Descriptor: Inj. tagraxofusp-erzs 10 mcg
b. Long Descriptor: Injection, tagraxofusp-erzs, 10 micrograms
c. TOS: 1

23) J9313
a. Short Descriptor: Inj., lumoxiti, 0.01 mg
b. Long Descriptor: Injection, moxetumomab pasudotox-tdfk, 0.01 mg
c. TOS: 1,P

24) Q4205
a. Short Descriptor: Membrane graft or wrap sq cm
b. Long Descriptor: Membrane graft or membrane wrap, per square centimeter
c. TOS: 1

25) Q4206
a. Short Descriptor: Fluid flow or fluid gf 1 cc
b. Long Descriptor: Fluid flow or fluid GF, 1 cc
c. TOS: 1

26) Q4208
a. Short Descriptor: Novafix per sq cm
b. Long Descriptor: Novafix, per square centimeter
c. TOS: 1

27) Q4209
a. Short Descriptor: Surgraft per sq cm
b. Long Descriptor: Surgraft, per square centimeter
c. TOS: 1

28) Q4210
a. Short Descriptor: Axolotl graf dualgraf sq cm
b. Long Descriptor: Axolotl graft or axolotl dualgraft, per square centimeter
c. TOS: 1

29) Q4211
a. Short Descriptor: Amnion bio or axobio sq cm
b. Long Descriptor: Amnion bio or Axobiomembrane, per square centimeter
c. TOS: 1

30) Q4212
a. Short Descriptor: Allogen, per cc
b. Long Descriptor: Allogen, per cc
c. TOS: 1

31) Q4213
a. Short Descriptor: Ascent, 0.5 mg
b. Long Descriptor: Ascent, 0.5 mg
c. TOS: 1 

32) Q4214
a. Short Descriptor: Cellesta cord per sq cm
b. Long Descriptor: Cellesta cord, per square centimeter
c. TOS: 1

33) Q4215
a. Short Descriptor: Axolotl ambient, cryo 0.1 mg
b. Long Descriptor: Axolotl ambient or axolotl cryo, 0.1 mg
c. TOS: 1

34) Q4216
a. Short Descriptor: Artacent cord per sq cm
b. Long Descriptor: Artacent cord, per square centimeter
c. TOS: 1

35) Q4217
a. Short Descriptor: Woundfix biowound plus xplus
b. Long Descriptor: Woundfix, BioWound, Woundfix Plus, BioWound Plus, Woundfix Xplus
or BioWound Xplus, per square centimeter
c. TOS: 1

36) Q4218
a. Short Descriptor: Surgicord per sq cm
b. Long Descriptor: Surgicord, per square centimeter
c. TOS: 1

37) Q4219
a. Short Descriptor: Surgigraft dual per sq cm
b. Long Descriptor: Surgigraft-dual, per square centimeter
c. TOS: 1

38) Q4220
a. Short Descriptor: Bellacell HD, Surederm sq cm
b. Long Descriptor: BellaCell HD or Surederm, per square centimeter
c. TOS: 1

39) Q4221
a. Short Descriptor: Amniowrap2 per sq cm
b. Long Descriptor: Amniowrap2, per square centimeter
c. TOS: 1

40) Q4222
a. Short Descriptor: Progenamatrix, per sq cm
b. Long Descriptor: Progenamatrix, per square centimeter
c. TOS: 1

41) Q4226
a. Short Descriptor: Myown harv prep proc sq cm
b. Long Descriptor: MyOwn skin, includes harvesting and preparation procedures, per square centimeter
c. TOS: 1 

42) Q5116
a. Short Descriptor: Inj., trazimera, 10 mg
b. Long Descriptor: Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg
c. TOS: 1,P

43) Q5117
a. Short Descriptor: Inj., kanjinti, 10 mg
b. Long Descriptor: Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg
c. TOS: 1,P

44) Q5118
a.Short Descriptor: Inj., zirabev, 10 mg
b.Long Descriptor: Injection, bevacizumab-bvzr, biosimilar, (Zirabev), 10 mg
c. TOS: 1,P

HCPCS codes J1942 (Aripiprazole lauroxil 1mg/Injection, aripiprazole lauroxil, 1 mg) and S1090 (Mometasone sinus implant/Mometasone furoate sinus implant, 370 micrograms) are being discontinued effective October 1, 2019; and may not be used in submitting claims to Medicare with dates of service on or after that date.

Effective for claims with dates of service on or after October 1, 2019, the long and short descriptors for the following HCPCS codes will be modified. The TOS and all other indicators will remain the same.

1) J0641
a. New Short Descriptor: Inj., levoleucovorin, 0.5 mg
b. New Long Descriptor: Injection, levoleucovorin, 0.5 mg

2) J2794
a. New Short Descriptor: Inj., risperdal consta, 0.5 mg
b. New Long Descriptor: Injection, risperidone (risperdal consta), 0.5 mg

3) J7311
a. New Short Descriptor: Inj., retisert, 0.01 mg
b. New Long Descriptor: Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01
mg
9
4) J7313
a. New Short Descriptor: Inj., iluvien, 0.01 mg
b. New Long Descriptor: Injection, fluocinolone acetonide, intravitreal implant (Iluvien), 0.01
mg

5) Q4122
a. New Short Descriptor: Dermacell, awm, porous sq cm
b. New Long Descriptor: Dermacell, dermacell awm or dermacell awm porous, per square centimeter

6) Q4165
a. New Short Descriptor: Keramatrix, Kerasorb sq cm
b. New Long Descriptor: Keramatrix or kerasorb, per square centimeter 

7) Q4184
a. New Short Descriptor: Cellesta or duo per sq cm

b. New Long Descriptor: Cellesta or cellesta duo, per square centimeter


Coding Ahead

Upcoming HCPCS (DELETED/REVISED) Code Changes Effective from October 1, 2019

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Deleted Codes:

J1942 Injection, aripiprazole lauroxil, 1 mg
S1090 Mometasone furoate sinus implant, 370 micrograms

Revised Codes:

J0641 Inj., levoleucovorin, 0.5 mg
J2794 Inj., risperdal consta, 0.5 mg
J7311 Inj., retisert, 0.01 mg
J7313 Inj., iluvien, 0.01 mg
Q4122 Dermacell, awm, porous sq cm
Q4165 Keramatrix, Kerasorb sq cm
Q4184 Cellesta or duo per sq cm


Coding Ahead

Upcoming HCPCS (NEW) Code Changes Effective from October 1, 2019

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New Codes:

J0121 Injection, omadacycline, 1 mg
J0122 Injection, eravacycline, 1 mg
J0222 Injection, Patisiran, 0.1 mg
J0291 Injection, plazomicin, 5 mg
J0593 Injection, lanadelumab-flyo, 1 mg (code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered)
J1096 Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
J1097 phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml
J1303 Injection, ravulizumab-cwvz, 10 mg
J1943 Injection, aripiprazole lauroxil, (aristada initio), 1 mg
J1944 Injection, aripiprazole lauroxil, (aristada), 1 mg
J2798 Injection, risperidone, (perseris), 0.5 mg
J3031 Injection, fremanezumab-vfrm, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered)
J3111 Injection, romosozumab-aqqg, 1 mg
J7314 Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg
J7331 Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg
J7332 Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg
J7401 Mometasone furoate sinus implant, 10 micrograms
J9118 Injection, calaspargase pegol-mknl, 10 units
J9119 Injection, cemiplimab-rwlc, 1 mg
J9204 Injection, mogamulizumab-kpkc, 1 mg
J9210 Injection, emapalumab-lzsg, 1 mg
J9269 Injection, tagraxofusp-erzs, 10 micrograms
J9313 Injection, moxetumomab pasudotox-tdfk, 0.01 mg
Q4205 Membrane graft or membrane wrap, per square centimeter
Q4206 Fluid flow or fluid GF, 1 cc
Q4208 Novafix, per square cenitmeter
Q4209 Surgraft, per square centimeter
Q4210 Axolotl graft or axolotl dualgraft, per square centimeter
Q4211 Amnion bio or Axobiomembrane, per square centimeter
Q4212 Allogen, per cc
Q4213 Ascent, 0.5 mg
Q4214 Cellesta cord, per square centimeter
Q4215 Axolotl ambient or axolotl cryo, 0.1 mg
Q4216 Artacent cord, per square centimeter
Q4217 Woundfix, BioWound, Woundfix Plus, BioWound Plus, Woundfix Xplus or BioWound Xplus, per square centimeter
Q4218 Surgicord, per square centimeter
Q4219 Surgigraft-dual, per square centimeter
Q4220 BellaCell HD or Surederm, per square centimeter
Q4221 Amniowrap2, per square centimeter
Q4222 Progenamatrix, per square centimeter
Q4226 MyOwn skin, includes harvesting and preparation procedures, per square centimeter
Q5116 Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg
Q5117 Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg
Q5118 Injection, bevacizumab-bvcr, biosimilar, (Zirabev), 10 mg


Coding Ahead

New HCPCS Modifiers Effective from Jan 1, 2020

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HCPCS Modifiers:

MA Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition
MB Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access
MC Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues
MD Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances
ME The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
MF The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
MG The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional
MH Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider


Coding Ahead