2012 HCPCS II Available With Over 430 Changes

The Centers for Medicare & Medicaid Services (CMS) released, Oct. 31,  the HCPCS Level II codes that go into effect Jan. 1, 2012. Changes include 285 code additions (and one new modifier), 48 revisions, and 75 deletions. Another 18 codes were added and eight deleted throughout 2011.

Level II modifier PD Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days has been added to help hospitals identify those services that fall within the Medicare “3-Day Payment Window.” The policy requires a hospital to combine the charges and appropriate codes for any outpatient diagnostic and “related” non-diagnostic services (other than ambulance and maintenance renal dialysis) provided within the three-day period immediately preceding an inpatient admission.

As in years past, many C and Q codes have been deleted and replaced by new J codes. To name a few examples: C9272 has been replaced by J0897 Injection, denosumab, 1 mg; Q2040 has been replaced by J0588 Injection, incobotulinumtoxin A, 1 unit; and Q2042 has been replaced by J1725 Injection, hydroxyprogesterone caproate, 1 mg.

Only a handful of C codes have been added for 2012, including C9287 for the lymphoma drug brentuximab vedotin and C9366 for the membrane/skin allograft EpiFix®. Similarly, there are fewer than a dozen new drug/supply Q codes for 2012. Among them are Q0162 for the anti-nausea drug ondansetron, Q2043 for sipuleucel-T, a therapeutic vaccine for prostate cancer, and nine new codes (Q4122-Q4130) for skin substitutes such as Dermacell®, Alloskin™ RT, and Talymed™.

A series of E codes (E0988, E2358-E2359, and E2626-E2633) newly describe various accessories (e.g., batteries, arm supports) for manual and power wheelchairs. Four new K codes (K0743-K0746) have been added for home suction pumps and supplies for wound healing (i.e., negative wound pressure therapy).

G codes for telehealth consultations (G0425-G0427) have been revised to apply both to initial and emergency department services.

The largest number of changes (209 additions, 27 revisions, and 28 deletions) affects those G codes used to report quality indicators for the Physician Quality Reporting System (PQRS). Eligible professionals (EPs) who successfully report on quality measures in the PQRS are eligible for a 0.5 percent Medicare payment incentive for years 2012-2014. In 2015, EPs and groups that do not report quality data successfully will face a 1.5 percent payment reduction in Medicare payments, and a 2 percent reduction for 2016.

The 2012 HCPCS Level II files are available on the CMS website. Visit the CMS website for additional information about PQRS and using PQRS measures codes.

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2 Responses to “2012 HCPCS II Available With Over 430 Changes”

  1. Diana Lewis says:

    Where could I find a list of the CHANGES ONLY. I have found the HCPCS Level II drug list. I thought there was a publication that listed the changes.

  2. LymphActivist says:

    What we really need is a set of L-Codes to cover the materials used in the treatment of lymphedema (compression bandages and padding, compression garments, compression devices, donning aids, etc.). Currently these materials are denied because they do not meet the coverage criteria for surgical dressings (A-Codes) or durable medical equipment (E-Codes). Compression materials used in the treatment of lymphedema meet the coverage criteria for “prosthetic devices” according to many U.S. Administrative Law Judges, and should therefore be coded with L-Codes. They restore the function of a permanently impaired internal organ and therefore meet the definition of a prosthetic device per the Medicare Benefit Policy Manual. Although HCPCS codes DO NOT determine coverage, in this case their coding causes them to be denied.

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