HCPCS Level II Changes Effective April 1

HCPCS Level II Changes Effective April 1

Now that you’re familiar with the 2018 HCPCS Level II codes,  new C, G, K, and Q codes effective April 1 have been released by the Centers for Medicare & Medicaid Services (CMS). Several modifiers have been adjusted to reflect oxygen use.

The annual quarterly updates helps CMS programs, such as the Outpatient Prospective Payment System (OPPS) adjust for newly approved services and payments. Of the code sets, HCPCS Level II remains the most dynamic.

Modifiers, Cs, Qs, and others

The changes below reflect all but the G codes.

What is Macra

HCPCS Long Description Action Short Description Effective           Date Termination Date Special Notes (Any reference or xref code)
QE Prescribed Amount Of Stationary Oxygen While At Rest Is Less Than 1 Liter Per Minute (LPM) Revise text Stationary o2 @ rest 4/1/2018    
QF Prescribed Amount Of Stationary Oxygen While At Rest Exceeds 4 Liters Per Minute (LPM) And Portable Oxygen Is Prescribed Revise text Station o2 @ rest >4LPM/port 4/1/2018    
QG Prescribed Amount Of Stationary Oxygen While At Rest Is Greater Than 4 Liters Per Minute (LPM) Revise text Station o2 @ rest > 4 LPM 4/1/2018    
QA Prescribed Amounts Of Stationary Oxygen For Daytime Use While At Rest And Nighttime Use Differ And The Average Of The Two Amounts Is Less Than 1 Liter Per Minute (LPM) Add Avg sta day/night o2 4/1/2018    
QB Prescribed Amounts Of Stationary Oxygen For Daytime Use While At Rest And Nighttime Use Differ And The Average Of The Two Amounts Exceeds 4 Liters Per Minute (LPM) And Portable Oxygen Is Prescribed Add Avg day/nite o2 > 4 LPM/port 4/1/2018    
QR Prescribed Amounts Of Stationary Oxygen For Daytime Use While At Rest And Nighttime Use Differ And The Average Of The Two Amounts Is Greater Than 4 Liters Per Minute (LPM) Add Avg sta day/night o2 > 4 LPM 4/1/2018    
ZA   Discontinue     4/1/2018  
ZB   Discontinue     4/1/2018  
ZC   Discontinue     4/1/2018  
C9462 Injection, delafloxacin, 1 mg Add Injection, delafloxacin 4/1/18   New OPPS pass-through drug code effective April 1, 2018.
C9463 Injection, aprepitant, 1 mg Add Injection, aprepitant 4/1/18   New OPPS pass-through drug code effective April 1, 2018.
C9464 Injection, rolapitant, 0.5 mg Add Injection, rolapitant 4/1/18   New OPPS pass-through drug code effective April 1, 2018.
C9465 Hyaluronan or derivative, Durolane, for intra-articular injection, per dose Add Injection, Durolane 4/1/18   New OPPS pass-through drug code effective April 1, 2018.
C9466 Injection, benralizumab, 1 mg Add Injection, benralizumab 4/1/18   New OPPS pass-through drug code effective April 1, 2018.
C9467 Injection, rituximab and hyaluronidase, 10 mg Add Inj rituximab hyaluronidase 4/1/18   New OPPS pass-through drug code effective April 1, 2018.
C9468 Injection, factor ix (antihemophilic factor, recombinant), glycopegylated, Rebinyn, 1 i.u. Add Inj, factor ix, Rebinyn 4/1/18   New OPPS pass-through drug code effective April 1, 2018.
C9469 Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg Add Inj triamcinolone acetonide 4/1/18   New OPPS pass-through drug code effective April 1, 2018.
C9749 Repair of nasal vestibular lateral wall stenosis with implant(s) Add Repair nasal stenosis w/imp 4/1/18   N/A
Q5101 Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram Revise text Injection, zarxio 4/1/2018    
Q5102    Discontinue   4/1/2018    
Q5103 Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg Add Injection, inflectra 4/1/2018   Processing Note:  0187
Q5104 Injection, infliximab-abda, biosimilar, (renflexis), 10 mg Add Injection, renflexis 4/1/2018   Processing Note:  0187
 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 Add  Mult den insert dir carv/cam 4/1/2018    
Q2041 Axicabtagene Ciloleucel, up to 200 Million Autologous Anti-CD19 CAR T Cells, Including Leukapheresis And Dose Preparation Procedures, Per Infusion Add Axicabtagene ciloleucel car+ 4/1/2018   1

G Code Changes

All but one of the G code changes are new codes for reporting Medicare’s Diabetes Prevent Program. One of the 17 codes is simply a short description change.

New Code  Long Descriptor  Short Descriptor  Effective Date  TOS 
G9873 First Medicare Diabetes Prevention Program (MDPP) core session was attended by an MDPP beneficiary under the MDPP Expanded Model (EM).  A core session is an MDPP service that: (1)  is furnished by an MDPP supplier during months 1 through 6 of the MDPP services period; (2)  is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for core sessions 1 EM core session 4/1/2018 TOS 1
G9874 Four total Medicare Diabetes Prevention Program (MDPP) core sessions were attended by an MDPP beneficiary under the MDPP Expanded Model (EM).  A core session is an MDPP service that: (1)  is furnished by an MDPP supplier during months 1 through 6 of the MDPP services period; (2)  is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for core sessions. 4 EM core sessions 4/1/2018 TOS 1
G9875 Nine total Medicare Diabetes Prevention Program (MDPP) core sessions were attended by an MDPP beneficiary under the MDPP Expanded Model (EM).  A core session is an MDPP service that: (1)  is furnished by an MDPP supplier during months 1 through 6 of the MDPP services period; (2)  is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for core sessions 9 EM core sessions 4/1/2018 TOS 1
G9876 Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 7-9 under the MDPP Expanded Model (EM).  A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.  The beneficiary did not achieve at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9.  2 EM core MS mo 7-9 no WL 4/1/2018 TOS 1
G9877 Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 10-12 under the MDPP Expanded Model (EM).  A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.

The beneficiary did not achieve at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12.

2 EM core MS mo 10-12 no WL 4/1/2018 TOS 1
G9878 Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 7-9 under the MDPP Expanded Model (EM).  A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.The beneficiary achieved at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9. 2 EM core MS mo 7-9  WL 4/1/2018 TOS 1
G9879 Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 10-12 under the MDPP Expanded Model (EM).  A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.The beneficiary achieved at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12 2 EM core MS mo 10-12 WL 4/1/2018 TOS 1
G9880 The MDPP beneficiary achieved at least 5% weight loss (WL) from his/her baseline weight in months 1-12 of the MDPP services period under the MDPP Expanded Model (EM).  This is a one-time payment available when a beneficiary first achieves at least 5% weight loss from baseline as measured by an in-person weight measurement at a core session or core maintenance session. EM 5 percent WL 4/1/2018 TOS 1
G9881 The MDPP beneficiary achieved at least 9% weight loss (WL) from his/her baseline weight in months 1-24 under the MDPP Expanded Model (EM).  This is a one-time payment available when a beneficiary first achieves at least 9% weight loss from baseline as measured by an in-person weight measurement at a core session, core maintenance session, or ongoing maintenance session. EM 9 percent WL 4/1/2018 TOS 1
G9882 Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 13-15 under the MDPP Expanded Model (EM).  An ongoing maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 13 through 24 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.The beneficiary maintained at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 13-15. 2 EM ongoing MS mo 13-15 WL 4/1/2018 TOS 1
G9883 Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 16-18 under the MDPP Expanded Model (EM).  An ongoing maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 13 through 24 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.

The beneficiary maintained at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 16-18.

2 EM ongoing MS mo 16-18 WL 4/1/2018 TOS 1
G9884 Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 19-21 under the MDPP Expanded Model (EM).  An ongoing maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 13 through 24 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions. The beneficiary maintained at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 19-21. 2 EM ongoing MS mo 19-21 WL   TOS 1
G9885 Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 22-24 under the MDPP Expanded Model (EM).  An ongoing maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 13 through 24 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.

The beneficiary maintained at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 22-24.

2 EM ongoing MS mo 22-24 WL 4/1/2018 TOS 1
G9890 Bridge Payment: A one-time payment for the first Medicare Diabetes Prevention Program (MDPP) core session, core maintenance session, or ongoing maintenance session furnished by an MDPP supplier to an MDPP beneficiary during months 1-24 of the MDPP Expanded Model (EM) who has previously received MDPP services from a different MDPP supplier under the MDPP Expanded Model.  A supplier may only receive one bridge payment per MDPP beneficiary.  EM Bridge Payment 4/1/2018 TOS 1
G9891 MDPP session reported as a line-item on a claim for a payable MDPP Expanded Model (EM)  HCPCS code for a session furnished by the billing supplier under the MDPP Expanded Model and counting toward achievement of the attendance performance goal for the payable MDPP Expanded Model HCPCS code.(This code is for reporting purposes only). EM session reporting 4/1/2018 TOS 1
G0516 Change in short descriptor  insert drug implant,>=4 4/1/2018  
Brad Ericson

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.
Brad Ericson

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About Has 340 Posts

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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