The Healthcare Common Procedure Coding System (HCPCS) codes represent codes assigned to procedures, supplies, products and services provided to Medicare and Medicaid beneficiaries. HCPCS codes are also used by private health plans. Medical coding and medical billing services are available to ensure standardized coding and proper claims processing for optimal reimbursement. Several HCPCS coding changes came into effect starting January 1, 2019.

  • About HCPCS Codes

    There are two levels of HCPCS codes. Level one is similar to CPT, but referred to as HCPCS when used to bill Medicare or Medicaid. Level II of HCPCS represents non-physician services such as ambulance services, durable medical equipment, and pharmacy. As CPT codes do not cover all the services provided during a patient encounter, HCPCS codes allow for more accurate reporting of services rendered. The medical documentation needs to reflect the medical necessity for billing of items reported with HCPCS level II codes. HCPCS codes have their own modifiers, though many are similar to the modifiers used with CPT codes.

  • 2019 Changes to Level II HCPCS Codes

    On November 6, 2018, Centers for Medicare & Medicaid Services (CMS) released HCPCS code changes that are effective for claims with dates of service on or after January 1, 2019. According to an AAPC article, there are 374 HCPCS code changes for 2019 which include:

    • 228 new codes and modifiers
    • 49 discontinued codes and modifiers
    • 95 changed codes and modifiers
    • 1 code with a coverage changes

    Key changes include new hearing aid codes, Medicaid screening and documentation codes, new injectable drugs, and new G codes for telehealth, evaluation and management, and quality measures.

    New Hearing Aid Codes

    There are 9 new HCPCS Level II codes that reflect new contralateral routing technology or CROS/BiCROS hearing devices. According to the the American Speech-Language-Hearing Association (ASHA), the revisions to the codes for reporting CROS/BiCROS devices “are an attempt to more accurately describe current hearing aid technology used to treat patients with single-sided deafness or patients with some degree of hearing loss in one ear and an unaidable hearing loss in the other.”

    In 2019, there are 3 new monaural codes to report one contralateral routing device and 6 binaural codes to report one hearing aid and one contralateral routing device (or a contralateral routing system):

    • V5171 Hearing aid, contralateral routing device, monaural, in the ear (ite)
    • V5172 Hearing aid, contralateral routing device, monaural, in the canal (itc)
    • V5181 Hearing aid, contralateral routing device, monaural, behind the ear (bte)
    • V5211 Hearing aid, contralateral routing system, binaural, ite/ite
    • V5212 Hearing aid, contralateral routing system, binaural, ite/itc
    • V5213 Hearing aid, contralateral routing system, binaural, ite/bte
    • V5214 Hearing aid, contralateral routing system, binaural, itc/itc
    • V5215 Hearing aid, contralateral routing system, binaural, itc/bte
    • V5221 Hearing aid, contralateral routing system, binaural, bte/bte

    In addition to this, the following 4 codes were revised from CROS to BiCROS” to “monaural or binaural contralateral routing”:

    • V5190 Hearing aid, contralateral routing, monaural, glasses
    • V5200 Dispensing fee, contralateral, monaural
    • V5230 Hearing aid, contralateral routing system, binaural, glasses
    • V5240 Dispensing fee, contralateral routing system, binaural

    Other New HCPCS Codes

    • C1890 No implantable/insertable device used with device-intensive procedures
    • J1095 Injection, dexamethasone 9 percent, intraocular, 1 microgram (effective January 1, 2019, code J1095 replaced deleted code C9034 Injection, dexamethasone 9%, intraocular, 1 mcg)
    • J2186 Injection, meropenem and vaborbactam, 10mg/10mg (20mg)
    • J2787 Riboflavin 5′-phosphate, ophthalmic solution, up to 3 ml
    • L8701 Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated
    • L8702 Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated<
    • Q5111 Injection, pegfilgrastim-CBGV, biosimilar, (UDENYCA), 0.5 mg

    Changes for Enteral Nutrition

    Enteral nutrition refers to any feeding which uses the digestive tract. The nutrition product may be taken orally through the mouth or sent to the stomach or intestines through a tube.

    New code B4105 In-line cartridge containing digestive enzyme(s) for enteral feeding, each replaces code Q9994 effective for claims with dates of service on or after January 1, 2019.

    Therapeutic Shoes for Persons with Diabetes

    Effective January 1, 2019, there are narrative changes to the descriptor for therapeutic shoes for persons with diabetes.

    New: Code A5513 For diabetics only, multiple density insert, custom molded from model of patient’s foot, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each

    Discontinued: Code K0903 For diabetics only, multiple density insert, made by direct carving with CAM technology from a rectified CAD model created from a digitized scan of the patient, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each

    Other HCPCS Codes with New Status

    • C1890 No implantable/insertable device used with device-intensive procedures
    • C9468 Injection, factor IX (antihemophilic factor, recombinant), glycopegylated, Rebinyn, 1 i.u
    • J7329 Hyaluronan or derivative, Trivisc, for intra-articular injection, 1 mg
    • Q2026 Injection, RADIESSE, 0.1 ml

    HCPCS Modifier reinstated

    CMS recently reinstated the following modifier introduced in 2011 which it said was “removed in error” when the code changes for 2019 were first announced:

    Modifier DA Oral health assessment by a licensed health professional other than a dentist remains effective since January 1, 2011.

  • Simplify Medical Billing with HCPCS Coding Services

    Each year, CPT and HCPCS code sets undergo several changes and revisions which become effective January 1. Code updates are also issued each quarter throughout the year. Experienced medical coding outsourcing companies keep track of these changes to help providers stay compliant, submit accurate claims, and avoid payment delays and denials.

Read our blog on HCPCS Level II Quarterly Updates Effective April 2021.