The Centers for Medicare & Medicaid Services (CMS) has implemented its proposal to introduce codes for the collection of Social Determinants of Health (SDOH). The latest update for the Healthcare Common Procedure Coding System (HCPCS) Level II, applicable from January 2024, is now accessible on the CMS website. This update comprises significant alterations, including the inclusion of 343 new codes, discontinuation of 74 codes, and modifications to existing codes in terms of descriptors, coverage, and payment details.
Details of the Changes:
New Medical Codes:
CMS is incorporating 343 new codes into the HCPCS Level II code set, effective January 1, 2024. These include:
- 75 “A” codes for transportation services, medical and surgical supplies, and administrative services.
- Numerous codes related to gradient compression materials.
- 21 “C” codes for outpatient services.
- 15 “E” codes for durable medical equipment (DME).
- 13 “G” codes for reporting professional procedures to Medicare, with notable attention to codes G0019-G0024, facilitating the reporting of time spent on SDOH data collection.
- 33 “J” codes for non-oral administered drugs.
- Three “L” codes for orthotic procedures and services.
- 160 “M” codes for reporting medical services.
- 23 “Q” codes, temporary codes for various services and supplies.
CMS is discontinuing 74 codes falling under categories “C,” “G,” “K” (DME), “M,” and “S” (temporary national).
Changes to Existing Codes:
The January 2024 quarterly update brings modifications to existing codes, including:
- Five codes with coverage and long descriptor changes (A6535, A6538, A6541, A6549).
- Seven “A” codes with coverage changes.
- 51 codes across “A,” “G,” “M,” “Q,” and “T” categories with long descriptor changes.
- 126 codes across “A,” “C,” “G,” “J,” and “Q” categories with payment changes.
- Four codes with short descriptor changes, including
- C9757 (Spine device implant surgery),
- G0176 (Outpatient Prospective Payment System / partial hospitalization program / intensive outpatient program; activity therapy),
- G0177 (Outpatient Prospective Payment System / partial hospitalization program / intensive outpatient program; train & education),
- Q2052 (Home ivig, services/supplies).
The HCPCS Level II quarterly update files are accessible for download on the CMS website, and Medicare Administrative Contractors have been directed to implement these changes by January 2, 2024.