HCPCS Level II Code Changes for 2020

HCPCS Level II code changes

Centers for Medicare & Medicaid Services (CMS) unveiled the HCPCS Level II code modifications for 2020 on November 8th. These alterations encompass an extensive array of fresh, revised, and eradicated codes, serving as the means to document Medicare Part B services.

The 2020 HCPCS Level II edition is set to incorporate a total of 191 novel codes and modifiers, along with 62 codes that have undergone revision and 79 codes and modifiers that will be deleted.

Key Aspects of the HCPCS Level II Code Adjustments

This iteration of the HCPCS Level II code set revamp introduces a series of new G and M codes, dedicated to documenting vaccine status and the documentation of degenerative neurological conditions, respectively.

While the introduction of these novel codes is certain to capture attention, it’s equally vital to highlight significant changes in code descriptors and the removal of codes. Among the revisions, particular emphasis should be placed on descriptor modifications for existing codes that trigger a range of quality measures in the Merit-Based Incentive Payment System (MIPS). For instance, the MIPS measure #405, focused on Appropriate Follow-up Imaging for Incidental Abdominal Lesions, will be impacted due to the omission of specific references to “abdominal” imaging from the descriptors in the code range G9548-G9551. This clarification is especially relevant because certain MIPS-eligible CPT® codes lack a mention of abdominal imaging, such as 76775 Ultrasound, retroperitoneal (e.g., renal, aorta, nodes), real time with image documentation; limited.

Moreover, MIPS quality measures and functional reporting codes will be influenced by the removal of certain HCPCS Level II codes. As a reminder, CMS employs functional reporting to gather information on beneficiaries’ functional limitations through a set of non-payable HCPCS Level II G codes. It’s crucial to distinguish these from functional status codes used for reporting preoperative and postoperative functional status.

Precisely, CMS is discontinuing 75 G and M codes previously used for reporting MIPS quality measures, functional reporting and status, and various drug administration services. In the context of MIPS, it’s imperative to update the roster of eligible quality measures to ensure favorable payment adjustments for the 2022 calendar year.

For more comprehensive insights, refer to the 2020 HCPCS Level II Expert resource, scheduled for release in December

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