HCPCS Level II Changes Effective April 1
- By Brad Ericson
- In CMS
- March 5, 2018
- No Comments
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.
| 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
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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