15 HCPCS Corrections to 2019 Code Set
- By Brad Ericson
- In Billing
- January 16, 2019
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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
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