15 HCPCS Corrections to 2019 Code Set

15 HCPCS Corrections to 2019 Code Set

The Centers for Medicare & Medicaid Services (CMS) has released 15 corrections to the 2019 HCPCS Level II code set, all retroactive.

Of the 15 codes, five are added, one discontinued, and seven reflect changes to payment or coverage status. One modifier introduced in 2011 CMS ruefully admits was “removed in error” and is reinstated.

Corrections to the HCPCS Level II code set are as sure as the Winter Solstice, and 2019 is no exception. However, in contrast to previous years, when the corrections would be released soon after the release of the updated file, the agency waited until the Christmas holidays, with the final file arriving in January.

Obviously, 2019 HCPCS Level II code books were already printed and being shipped when these changes were announced. If they affect your medical coding, make notes in your book.

HCPCS Codes Added

The following added codes were all effective January 1.

CODE LONG DESC TOS BETOS COV PRICE ASC IND ASC DATE
C1890 No implantable/insertable device used with device-intensive procedures 9,F D1E D 53
J1095 Injection, dexamethasone 9 percent, intraocular, 1 microgram 9,F O1E D 53 YY 1/1/2019
J2186 Injection, meropenem and vaborbactam, 10mg/10mg (20mg) 1 O1E C 51 YY 1/1/2019
J2787 Riboflavin 5’-phosphate, ophthalmic solution, up to 3 ml 1 O1E C 51
Q5111 Injection, pegfilgrastim-CBGV, biosimilar, (UDENYCA), 0.5 mg 1,P O1E C 53 YY 1/1/2019

Deleted HCPCS Code

One code has been deleted: C9034 Injection, dexamethasone 9%, intraocular, 1 mcg is replaced effective January 1 with the new code J1095 Injection, dexamethasone 9 percent, intraocular, 1 microgram.

HCPCS with New Status

The following changes also are effective January 1 save for Q9994, which became effective December 3, 2018.

CODE LONG DESC ACTION
A5513 For diabetics only, multiple density insert, custom molded from model of patient’s foot, 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 Change Action code to “F” and add Action Effective date
B4105 In-line cartridge containing digestive enzyme(s) for enteral feeding, each Change Cov to C and Price to 39
C1890 No implantable/insertable device used with device-intensive procedures Add “YY” ASC Ind
C9468 Injection, factor IX (antihemophilic factor, recombinant), glycopegylated, Rebinyn, 1 i.u. Change xref code to J7203
J7329 Hyaluronan or derivative, Trivisc, for intra-articular injection, 1 mg Add “YY” ASC Ind
Q2026 Injection, RADIESSE, 0.1 ml Remove “YY” ASC Ind and ASC Start date of 01/01/2019
Q9994 In-line cartridge containing digestive enzyme(s) for enteral feeding, each Change Cov to C and Price to 39

HCPCS’ Lost Modifier

Modifier DA Oral health assessment by a licensed health professional other than a dentist was removed in error and remains effective since January 1, 2011.

Quarter 2 changes to the HCPCS Level II code set may be delayed by the government shutdown, but will be released before their April 1 effective date.

Brad Ericson

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.
Brad Ericson

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About Has 394 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.

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