CMS Makes Late Changes to 2018 HCPCS II

The Centers for Medicare & Medicaid Services (CMS) announced January changes to the 2018 HCPCS Level II code set, released in November 2017.  The changes to C codes include retroactive effective dates and to several elements in G codes. The changes are below and do not show up in any publishers’ books:

CODE	ACTION	EFF DATE	SHORT DESC	LONG DESC
C9488	Change ASC Ind/ASC eff date	4/1/2017
C9745	Change ASC Ind/ASC eff date	7/1/2017
C9746	Change ASC Ind/ASC eff date	7/1/2017
C9747	Change ASC Ind/ASC eff date	7/1/2017
C9748	Change ASC Ind/ASC eff date	1/1/2018
G0279	Revise Long Desc	1/1/2018		Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
G0499	Add Lab Cert code 220	1/1/2018
G9367	Revise Long & Short Desc	1/1/2018	>= 2 same hi-rsk med ord	At least two orders for the same high-risk medication
G9368	Revise Long & Short Desc	1/1/2018	>= 2 same hi-rsk med not ord	At least two orders for the same high-risk medications not ordered
G9637	Should not have been updated – revert back to 2017 description
G9638	Should not have been updated – revert back to 2017 description
G9868	ADD Code	1/1/2018	Next Gen ACO model <10min	Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use under the Next Generation ACO model, less than 10 minutes
G9869	ADD Code	1/1/2018	Next Gen ACO model 10-20min	Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use under the Next Generation ACO model, 10-20 minutes
G9870	ADD Code	1/1/2018	Next Gen ACO model >20min	Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use under the Next Generation ACO model, 20 or more minutes
G9481	Revise Long Desc	1/1/2018		Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved CMS innovation center demonstration project, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9482	Revise Long Desc	1/1/2018		Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved CMS innovation center demonstration project, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9483	Revise Long Desc	1/1/2018		Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved CMS innovation center demonstration project, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9484	Revise Long Desc	1/1/2018		Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved CMS innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9485	Revise Long Desc	1/1/2018		Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved CMS innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9486	Revise Long Desc	1/1/2018		Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved CMS innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9487	Revise Long Desc	1/1/2018		Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved CMS innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9488	Revise Long Desc	1/1/2018		Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved CMS innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9489	Revise Long Desc	1/1/2018		Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved CMS innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9490	Revise Long and Short Desc	1/1/2018	CMMI mod home visit	CMS innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved CMS innovation center models); may not be billed for a 30 day period covered by a transitional care management code
G9890	DELETE
G9891	DELETE
G9989	DO NOT ADD – Remove from previous corrections document
G9990	DO NOT ADD – Remove from previous corrections document

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Brad Ericson

Director of Publishing at AAPC

Brad Ericson, MPC, CPC, COSC, is a seasoned healthcare writer and editor.He directed publishing at AAPC for nearly 12 years and worked at Ingenix 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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CMS Makes Late Changes to 2018 HCPCS II was last modified: January 15th, 2018 by Brad Ericson

About Brad Ericson Has 337 Posts

Brad Ericson, MPC, CPC, COSC, is a seasoned healthcare writer and editor. He directed publishing at AAPC for nearly 12 years and worked at Ingenix 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.

No Responses to “CMS Makes Late Changes to 2018 HCPCS II”

1. Dan Medders says:

   January 16, 2018 at 1:46 pm

   It seemed that CMS chose to remove the redundancies between G9890-G9891 and G9974-G9975, but kept those in G9892-G9893 and G9976-G9977. Is a coder to distinguish the difference between AAPC sections labeled “Vision Exams” and “Vision Assessments” when the Long Descriptions are identical?
   https://coder.aapc.com/hcpcs-codes-range/477
   https://coder.aapc.com/hcpcs-codes-range/490

2. CHASITY STOTLER says:

   February 22, 2018 at 6:49 am

   Are these changes printed some place? I am having many problems getting the G0279 paid on my claims. I have to submit documentation that the code is updated to use the new mammogram codes.

3. Brad Ericson says:

   March 28, 2018 at 7:31 am

   You can find them on the CMS website, but your best bet is contacting the payer.

4. Chasity Stotler says:

   April 19, 2018 at 11:12 am

   I have multiple payers still denying the G0279 stating it wasn’t billed with the appropriate primary code. When I try to appeal or dispute, they are insistant that in the HCPC book it states to bill with G0204 and G0206 which was not on our claim. I have sent copies of CMS policies. the links to the website to view the table, and copies of the HCPC book showing the old codes are not in the book anymore. Is anyone else having this issue with insurances? Have you had any luck getting them to pay the claims? And if you have, what did you do that I haven’t? I’m just at a loss at this point.