CMS Includes HCPCS Level II Code Changes

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. This complete rundown will help you prepare.

Wound Care and Graft Supply Codes

The October update to the HCPCS Level II code set includes a handful of new codes for wound management supplies. Check the descriptors for the trade name of the wound covering to select the correct code. Also, be sure to watch the billing units to ensure proper reporting.

A2014   Omeza collagen matrix, per 100 mg

A2015   Phoenix wound matrix, per square centimeter

A2016   Permeaderm b, per square centimeter

A2017   Permeaderm glove, each

A2018   Permeaderm c, per square centimeter

The October HCPCS Level II update also includes a revision to a code for human tissue allografts (grafts where the recipient is not the donor), which providers may use for tissue augmentation, such as in abdominal wall reconstruction or rotator cuff repair. Again, check the descriptor for trade names to choose the correct code.

Old:       Q4128   FlexHD, AllopatchHD, or MatrixHD, per square centimeter

New:     Q4128   Flex hd, or allopatch hd, per square centimeter

Codes for Systems, Devices, and Other Supplies

HCPCS Level II codes represent a wide range, including durable medical equipment, medical supplies, and devices. The October update includes many code revisions.

First are the codes for cranial electrotherapy stimulation (CES). Before Oct. 1, you had a single code for the system, supplies, and accessories: K1002 Cranial electrotherapy stimulation (ces) system, includes all supplies and accessories, any type.

CES: But as of Oct. 1, you should split that code into two separate options. Note the revised descriptor for K1002 limits the code to the system only. Use the new A code per month for supplies and accessories:

A4596   Cranial electrotherapy stimulation (ces) system supplies and accessories, per month

K1002    Cranial electrotherapy stimulation (ces) system, any type

Code K1002 isn’t the only revision to watch for this type of code. Check out the changes below, as well.

Digital therapy: Check for the addition of “cognitive and/or” in revised code A9291.

Chest wall oscillation system: Don’t miss the addition of “with full anterior and/or posterior thoracic region receiving simultaneous external oscillation” in revised code E0483.

Tremor stimulator: Make sure that you catch this tremor stimulator code change:

Old         K1019    Monthly supplies for use of device coded at k1018

New       K1019    Replacement supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist

Intramuscular sensor: You will use new code C1834 Pressure sensor system, includes all components (e.g., introducer, sensor), intramuscular (implantable), excludes mobile (wireless) software application for a pressure sensor system implanted into a muscle.

Pressure-reducing underlay: New code E0183 Powered pressure reducing underlay/pad, alternating, with pump, includes heavy duty reports a system used to reposition the patient to reduce the risk of pressure damage. Use of this system is appropriate for patients who can’t change position without assistance.

Codes for Drugs and Other Agents

Whether you report A, C, J, or Q codes, you may find something in this section that applies to you. All the changes in this section have an Oct. 1 effective date.

Radioactive agents/radiopharmaceuticals: If you report radioactive diagnostic agents for PET imaging, make note of these two codes. The second code is specific to Locametz®.

A9602   Fluorodopa f-18, diagnostic, per millicurie

A9800   Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurie

There is also a new code for a radiopharmaceutical (Pluvicto™) used to treat prostate cancer:

A9607 Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie.

Lanreotide: If you report lanreotide, you now need to distinguish existing code J1930 Injection, lanreotide, 1 mg from a new code specific to lanreotide sold by Cipla: J1932 Injection, lanreotide, (cipla), 1 mg.

There also is a new code for the intravenous melanoma treatment Opdualag™: J9298 Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg.

OPPS: If you report for Outpatient Prospective Payment System (OPPS) hospitals, don’t miss these C codes for Olinvyk® and Alymsys®, respectively:

C9101    Injection, oliceridine, 0.1 mg

C9142    Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg

Replacement codes: For providers that are not OPPS hospitals, there’s good news with several HCPCS Level II codes switching from the C code range (limited almost exclusively to OPPS use) to other ranges (available to other providers).

Codes for Doula and Chaplain Services

Check payer policies effective Oct. 1 to see if they will cover doula and chaplain services reported using the HCPCS Level II codes below.

Doula: “Maryland Department of Health submitted a request to establish a new HCPCS Level II code to identify doula birth worker attendance at labor and delivery,” according to the June 9, 2022, CMS HCPCS Level II public meeting agenda. “Services provided during labor and delivery may include emotional support as well as physical comfort measures to the individual and their partner while giving birth that are not clinical interventions.” The new codes are T codes, which means you shouldn’t expect Medicare to accept them, but Medicaid and private payers may.

T1032    Services performed by a doula birth worker, per 15 minutes

T1033    Services performed by a doula birth worker, per diem

Chaplain: HCPCS Level II revised the codes below to replace “by Department of Veterans Affairs chaplain” to simply “by chaplain.” You can read more about the original intent of these codes in the June 1, 2020, HCPCS Level II public meeting agenda:

Q9001   Assessment by chaplain services

Q9002   Counseling, individual, by chaplain services

Q9003   Counseling, group, by chaplain services

Medicaid Standalone Vax Counseling Codes (May 2022)

Several codes for standalone immunization counseling are also included in the October HCPCS Level II update file. These codes went into effect May 11, 2022, and are appropriate for Medicaid billing when the provider counsels the patient on immunization but does not administer a vaccine.

Review the descriptors for G0310-G0315 to select the correct options based on the amount of time, patient age, COVID-19 focus, and Medicaid program.

G0310   Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time

G0311   Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 16-30 mins time

G0312   Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time

G0313   Immunization counseling by a physician or other qualified health care professional when  the vaccine(s) is not administered on the same date of service for ages under 21, 16-30 mins time

G0314   Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 16-30 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)

G0315   Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 5-15 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)

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