Medicare Compliance & Reimbursement

CMS changes its mind, reinstating Albuterol HCPCS codes this April In a move sure to surprise some coders and exasperate others, the Centers for Medicare & Medicaid Services (CMS) announced that it will reinstate four recently deleted HCPCS codes for Albuterol and Levalbuterol. New codes: According to the latest HCPCS quarterly release, you'll find 15 updates that take effect Apr. 1. Five of these are additions to the HCPCS code set: • K0672 -- Addition to lower extremity orthosis, removable soft interface, replacement only • Q4096 -- Injection, Von Willebrand factor complex • Q4097 -- Injection, immune globulin (Privigen), intravenous, non-lyophilized, 500 mg • Q4098 -- Injection, iron dextran, 50 mg • S3628 -- Placental alpha microglobulin-1 rapid immunoassay for detection of rupture of fetal membranes Coverage status: Of the five new codes above, CMS describes S3628 as "not payable by Medicare," but the other four are payable based on "carrier judgment." "Although S3628 is not payable by Medicare, other insurers may pay it, which could pave the way for future Medicare coverage," says Sarah King of Randall Ob-Gyn. Codes reinstated: The new HCPCS code set reinstates Albuterol codes J7611 and J7613, as well as Levalbuterol codes J7612 and J7614. The coverage for these codes is noted as "special coverage instructions apply." Flashback: You may recall that last July, Medicare carriers began to deny payment for J7611-J7614, replacing them with Q4093-Q4094. "Both Q4093 and Q4094 were deleted effective Jan. 1, 2008," says Jay Neal, a coding consultant in Atlanta. "HCPCS introduced new Albuterol-Levalbuterol combination codes J7602-J7603 to take the place of those deleted Q codes for 2008." In the new HCPCS revision effective April 1, CMS revises the status of Albuterol codes J7602-J7603 and iron dextran injection codes J1751-J1752 to "not payable by Medicare." "The most likely rationale for the flip-flop here is that Medicare decided it was a better idea to use the four codes that separated Albuterol from Levalbuterol, rather than the J7602-J7603 codes, which had combined them," Neal says. More information: To review the HCPCS update, visit http://www.cms.hhs.gov/HCPCSReleaseCodeSets and click on "HCPCS Quarterly Update."