On May 21, the Centers for Medicare & Medicaid Services (CMS) published the anticipated quarterly update to the HCPCS Level II code set. This update is significant as it introduces a total of 39 new codes.
In addition to these new codes, the update also features several important descriptor changes, payment updates, and a handful of corrections. All coding staff and coding software systems must be fully updated before these changes officially take effect on July 1, 2026. By staying current with these updates, healthcare organizations can help ensure smooth claims processing while reducing the risk of claim rejections or denials caused by outdated codes or descriptors.
Highlights of the July Quarterly Update
The quarterly update to the HCPCS Level II code set for July comprises:
- 39 new codes that expand the current code set and address new procedures, services, and treatments.
- 4 codes have undergone administrative field changes that affect how providers apply or process them.
- One code has been discontinued and is no longer valid for use, reflecting evolving standards of care and changes in available therapies.
- 5 codes that have updates to their long descriptions, providing more detailed or accurate information on the service or product covered.
- 2 codes with revised short descriptions, offering clearer, more concise summaries for coding staff.
- 1 new modifier added to the set, supporting more precise billing for specific care scenarios.
- 5 corrections to previous codes or descriptors to resolve errors or inconsistencies.
Detailed Review of Code Changes
New Codes Introduced:
Among the 39 new codes, several are especially notable for their clinical impact. For example:
- A9574: Injection, ferumoxytol, 1 mg.
- C1609: Vertebral device, motion-preserving, with screw fixation.
- C8014: Cystourethroscopy with ureteroscopy and/or pyeloscopy, with lithotripsy, including use of a suction-enabled ureteral access sheath (if performed).
- C9310: Injection, leucovorin calcium (avyxa), 1 mg.
The introduction of code C8014, alongside a descriptor change for C9761, is intended to clarify coding practices for cystourethroscopy procedures, especially when a steerable vacuum-assisted ureteral catheter is used—a topic that has been a source of ongoing debate among providers and suppliers.
In addition to these, there are:
- 12 new G codes for co-management services, reflecting expanded collaborative care models.
- 12 new J codes for injectable medications, accommodating new drugs on the market.
- 9 new Q codes for various miscellaneous items and services.
- 2 new M codes, including:
- M0231: Intravenous infusion, tocilizumabbavi, for hospitalized adult COVID-19 patients receiving systemic corticosteroids and requiring supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (first dose, includes infusion and monitoring).
- M0232: Same as above, for the second dose.
Administrative Field Changes:
Four codes relating to premarket approval non-sheet skin substitutes (G0681, G0682, G0683, G0684) have had changes to their administrative fields, which may affect billing procedures. Additionally, J0897 for denosumab (1 mg) has a miscellaneous field change.
Discontinued Code:
The code C9309 (Injection, onasemnogene abeparvovec-brve, per treatment) has been discontinued, despite being newly introduced as of April 1, 2026.
Long Description Updates:
Five codes have had changes to their long descriptions, providing additional detail or clarification:
- C9761: Now specifies that the procedure involves a steerable, vacuum-assisted ureteral catheter, and should only be used when all components are performed.
- C9809: Clarifies the use of cryoneurolysis cryoablation needles, such as the iovera system, including all relevant disposable system components, with a specification for Medicare-qualifying non-opioid medical devices for post-surgical pain relief.
- J1569: Updated for immune globulin (gammagard liquid/gammagard liquid erc), specifying it is non-lyophilized (liquid) and the dose is 500 mg.
- J2787: Now indicates riboflavin 5′-phosphate, ophthalmic solution (photrexa viscous/photrexa), up to 3 ml.
- J3375: Injection, vancomycin hydrochloride (tyzavan xellia), clarified as not therapeutically equivalent to J3373, and specifies a dose of 10 mg.
The descriptor change to C9761 is particularly important, as it ensures the code is used only when all steps are performed and a steerable, vacuum-assisted ureteral catheter is utilized.
The American Hospital Association (AHA) has clarified that the use of a sheath does not qualify as a steerable ureteral catheter (AHA Coding Clinic®, Vol. 26, No. 1, First Quarter 2026).
Short Description Updates:
Two codes have had their abbreviated descriptions updated for clarity:
- A4459: Now reads “Transanal irrigation, manual” (previously “Transanal irrigation, any”).
- A4479: Now “Transanal irrigation, electr” (previously “Electro pump enema, reusable”).
Payment Changes:
Effective July 1, 2026, four codes will have updated payment classifications under the Ambulatory Surgical Center Prospective Payment System:
- J1741: Injection, ibuprofen, 100 mg
- Q5098: Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg
- Q5156: Injection, tocilizumab-anoh (avtozma), biosimilar, 1 mg
- Q5161: Injection, denosumab-kyqq (aukelso/bosaya), biosimilar, 1 mg
Code Corrections:
The July update also removes three proposed codes (G0685, G0572, G0573), and revises the long descriptor for a new code:
- G0678: Standard co-management service payment for documented review of clinical updates from ACCESS participants managing behavioral health (BH) conditions (such as depression and anxiety); per review.
G0678 is associated with the ACCESS (Advancing Chronic Care with Effective Scalable Solutions) model. Starting July 5, 2026, clinicians who co-manage ACCESS beneficiaries can bill for a new co-management service that covers documented reviews of ACCESS clinical updates and related care coordination activities.
Additionally, providers can now use the new AC modifier with code G0678 to report initial onboarding support services, including beneficiary enrollment, device or app setup, and care coordination activities. However, providers may apply the AC modifier only during the first month and only once per beneficiary per track.
Source: https://www.aapc.com/blog/94148-cms-updates-hcpcs-level-ii-code-set/