CMS Updates HCPCS Level II for Q2


Medical Coding Updates and Insights Unveiled

Effective April 1, 2022, the HCPCS Level II code set, which is employed to record medical services and provisions, will encompass the integration of 37 novel codes. Furthermore, the second quarter revision encompasses the elimination of five codes and a refinement of the description for one modifier.

Lay Terms for New Codes

As part of the HCPCS Level II code set expansion in the second quarter, several new codes are being introduced, responding to requests made by industry stakeholders during the biannual HCPCS public gathering conducted by the Centers for Medicare & Medicaid Services (CMS) for non-drug and non-biological items and services on December 1-2, 2021.

It’s important to note that code proposals are not finalized during these public meetings, but an in-depth understanding of the reasons behind an approval or denial can be obtained by reviewing the meeting agendas. For instance, the introduction of new codes includes:

K1028 – Denoting a power source and control electronics unit for an oral device/appliance designed for neuromuscular electrical stimulation of the tongue muscle, aimed at mitigating snoring and obstructive sleep apnea. This system can be managed via a smartphone application.

K1029 – Representing an oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, intended to be used in conjunction with the aforementioned power source and control electronics unit, also controllable through a smartphone application. This code applies to a 90-day supply.

These codes emerge from the initiative of Signifier Medical Technologies, LLC (SMT), which sought the creation of codes to identify the eXciteOSA durable control unit. This device utilizes neuromuscular stimulation of the tongue for addressing mild obstructive sleep apnea. SMT highlighted the absence of existing HCPCS codes describing a tongue neuromuscular stimulation device for OSA. Additionally, SMT requested a separate code for the disposable mouthpiece (K1029).

The California Department of Healthcare Services put forth a request for CMS to establish codes pertaining to skills training and development, self-directed financial management under waiver, and self-directed supports brokerage. These codes cater to the enhanced benefits offered under the Medi-Cal managed care program known as In Lieu of Services.

Resultant codes include:

H2038 – Encompassing skills training and development on a per diem basis.

T2050 – Covering self-directed financial management under a waiver, per diem.

T2051 – Describing self-directed supports brokerage under a waiver, per diem.

Koya Medical, Inc. petitioned for the revision of HCPCS Level II codes E0651, E0667, and E0669. Koya noted that the current code descriptors are confined to ‘pneumatic’ compression. In response, CMS formulated new codes to represent non-pneumatic compressors utilized for treating fluid collection (lymphedema) in the legs.

K1031 – Referring to a non-pneumatic compression controller devoid of calibrated gradient pressure.

K1032 – Designating a non-pneumatic sequential compression garment for the entire leg.

K1033 – Identifying a non-pneumatic sequential compression garment for half the leg.

In a similar vein, Koya had previously requested a code for a non-pneumatic compression control with calibrated gradient pressure (K1024) and a compression garment for the full arm (K1025).

PolyMedics Innovations Inc. (PMI) advocated for the introduction of a new code to delineate the Supra SDRM and Suprathel, which are resorbable synthetic skin substitutes used for treating various wounds. PMI pointed out the absence of an existing HCPCS Q code that accurately describes the use of these products in a physician’s office setting.

Effective April 1, the following codes will be available to report these supplies:

A2011 – Designating Supra SDRM per square centimeter.

A2012 – Denoting Suprathel per square centimeter.

Triad Life Sciences, Inc. submitted a request for a code to signify InnovaMatrix FS, a sterile single-use medical device derived from porcine placental material, intended for safe and effective wound treatment.

Effective April 1, the code below will be applicable for reporting InnovaMatrix FX:

A2013 – Indicating Innovamatrix fs per square centimeter.

HCPCS Level II Deletions and Revisions in Q2

The upcoming second quarter update incorporates the elimination of five codes. These codes include chemotherapy injection codes C9084 to C9087 and clinical decision support mechanism code G1009.

Moreover, a modification has been made to the descriptor for modifier FT, aiming to enhance clarity regarding its usage. The modifier FT is now refined to specify its purpose, which is to identify a service unrelated to an evaluation and management (E/M) visit within a global procedure. This is relevant when an E/M visit is conducted within the global period but is unrelated, or when additional E/M visits on the same day are unrelated