Mild HCPCS Drug/Bio Changes for July

The Centers for Medicare and Medicaid Services (CMS) announced a handful of changes to HCPCS Level II codes in its quarterly update.

The following codes will be payable for Medicare:

Code Descriptor TOS Code SI
Q2023 Injection, Factor VIII (Antihemophilic Factor, Recombinant) (Xyntha), Per I.U. 1 E
Q4115 Skin substitute, Alloskin, per square centimeter 1 E
Q4116 Skin substitute, Alloderm, per square centimeter 1 E

The Medicare Coverage Indicator for certain J codes was incorrectly listed on the January 2009, HCPCS Level II code set file. With the July 2009 quarterly update to the HCPCS Level II code set, CMS is correcting the file to show a Medicare Coverage Indicator of the letter “D.” The letter “D” indicates “special coverage instructions apply” and the applicable special coverage instructions are provided in the local coverage determinations (LCD) regarding inhalation drugs.

The affected J codes are:

J7611 Albuterol non-comp con
J7612 Levalbuterol non-comp con
J7613 Albuterol non-comp unit
J7614 Levalbuterol non-comp unit

These updates are based on transmittal 1752, change request (CR) 6477, issued June 5, and are effective for claims with service dates on or after April 1, 2008.


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