CMS Releases 2016 HCPCS Corrections
- By Brad Ericson
- In Audit
- December 3, 2015
- 5 Comments
By Brad Ericson, MPC, CPC, COSC
The Centers for Medicare and Medicaid Services released 49 corrections to the 2016 HCPCS Level II code set December 2, too late to be included in any 2016 HCPCS Level II codebook because publishers had already sent their books to print. But don’t fail to update as there are around 350 new edits in the 2016 HCPCS books already.
Some changes, such as G0477-G0483, were foreshadowed in the final CLIA guidelines for 2016, but most are changes to descriptions and deletions since the release of the data a month prior. All go into effect January 1, 2016. Here are the changes:
| CODE | ACTION | EFF DATE | SHORT DESC | LONG DESC |
| G0298 | Remove code – not valid (was replaced with G0475) | |||
| G0472 | Add pricing indicator 21 | 1/1/2016 | ||
| G0477 | Add new code | 1/1/2016 | Drug test presump optical | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service |
| G0478 | Add new code | 1/1/2016 | Drug test presump opt inst | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service |
| G0479 | Add new code | 1/1/2016 | Drug test presump not opt | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service |
| G0480 | Add new code | 1/1/2016 | Drug test def 1-7 classes | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed |
| G0481 | Add new code | 1/1/2016 | Drug test def 8-14 classes | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed |
| G0482 | Add new code | 1/1/2016 | Drug test def 15-21 classes | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed |
| G0483 | Add new code | 1/1/2016 | Drug test def 22+ classes | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed |
| G6030 | Delete code | 1/1/2016 | ||
| G6031 | Delete code | 1/1/2016 | ||
| G6032 | Delete code | 1/1/2016 | ||
| G6034 | Delete code | 1/1/2016 | ||
| G6035 | Delete code | 1/1/2016 | ||
| G6036 | Delete code | 1/1/2016 | ||
| G6037 | Delete code | 1/1/2016 | ||
| G6038 | Delete code | 1/1/2016 | ||
| G6039 | Delete code | 1/1/2016 | ||
| G6040 | Delete code | 1/1/2016 | ||
| G6041 | Delete code | 1/1/2016 | ||
| G6042 | Delete code | 1/1/2016 | ||
| G6043 | Delete code | 1/1/2016 | ||
| G6044 | Delete code | 1/1/2016 | ||
| G6045 | Delete code | 1/1/2016 | ||
| G6046 | Delete code | 1/1/2016 | ||
| G6047 | Delete code | 1/1/2016 | ||
| G6048 | Delete code | 1/1/2016 | ||
| G6049 | Delete code | 1/1/2016 | ||
| G6050 | Delete code | 1/1/2016 | ||
| G6051 | Delete code | 1/1/2016 | ||
| G6052 | Delete code | 1/1/2016 | ||
| G6053 | Delete code | 1/1/2016 | ||
| G6054 | Delete code | 1/1/2016 | ||
| G6055 | Delete code | 1/1/2016 | ||
| G6056 | Delete code | 1/1/2016 | ||
| G6057 | Delete code | 1/1/2016 | ||
| G6058 | Delete code | 1/1/2016 | ||
| G8925 | Change Short and Long Desc | 1/1/2016 | FEV>=60% & no COPD sym | Spirometry test results demonstrate FEV1 >= 60% predicted or patient does not have COPD symptoms |
| G9226 | Remove ? in Long Desc | 1/1/2016 | Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed) | |
| G9448 | Remove ? in Long Desc | 1/1/2016 | Patients who were born in the years 1945-1965 | |
| G9574 | Remove the period in Long Desc | 1/1/2016 | Remission at six months not demonstrated by a six month (+/-30 days) phq-9 score of less than five; either phq-9 score was not assessed or is greater than or equal to five | |
| G9666 | Remove ? in Long Desc | 1/1/2016 | The highest fasting or direct ldl-c laboratory test result of 70-189 mg/dl in the measurement period or two years prior to the beginning of the measurement period | |
| G9668 | Remove code – not valid | |||
| G9676 | Remove ? In Long Desc | 1/1/2016 | Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with an LDL-C result of 70-189 mg/dL recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period | |
| J0571 | Change Long Desc | Buprenorphine, oral, 1 mg | ||
| J7205 | Change Long Desc | 1/1/2016 | Injection, factor viii fc fusion protein (recombinant), per iu | |
| L1902 | Long desc – “similiar” should be “similar” | Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf | ||
| L1904 | Long desc – “similiar” should be “similar” | Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated | ||
| Q9975 | Change Long Desc | 4/1/2015 | Injection, factor viii fc fusion protein (recombinant), per iu |
Brad Ericson
Director of Publishing at AAPC
Brad Ericson, MPC, CPC, COSC, has been director of publishing for more than 11 years. Before AAPC he was at Optum for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.
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2016 New drug testing G-codes G0477 – G0483 are not being accepted by Medicare until April 2016 (claims being denied) since addendum B is yet to be updated due to the delayed release. Do you have any updates on this?
J7205 cpt code’s are begin denied from medicare for units- But we have it as 1 units and they are stating that box 19 needs the frequency?? We are stomped and don’t know what the correct answer is
Our latest quarterly HCPCS shows that CMS is re-activating G0298 – does anyone know what it going on with this change? Thanks
Can anyone tell me the replacement code of G9584 as it is being denied by MCR and MCD continuously. Your response will be highly appreciated.
Try using 80300