HCPCS - General Information

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ANNOUNCEMENT OF SHORTER CODING CYCLE PROCEDURES, APPLICATIONS, AND DEADLINES FOR 2020

The Centers for Medicare & Medicaid Services (CMS) is updating its Healthcare Common Procedural Coding System (HCPCS) Level II coding procedures to enable shorter and more frequent HCPCS code application cycles.  Beginning in January 2020, CMS will implement quarterly HCPCS code application opportunities for drugs and biological products; and bi-annual application opportunities for durable medical equipment, orthotics, prosthetics and supplies, and other non-drug, non-biological products.  As announced in May by CMS Administrator Seema Verma, this change is part of CMS’ broader, comprehensive initiative to foster innovation and expedite adoption of and patient access to new medical technologies.   

CMS’ delivery on this important goal necessitated procedural changes that balance the need to code more frequently with the amount of time necessary to accurately process applications.   CMS has released two documents containing detailed information pertaining to our updated HCPCS Level II Coding procedures, application instructions, and deadlines for 2020, titled: “Healthcare Common Procedure Coding System (HCPCS) Level II Coding Procedures”, and “Healthcare Common Procedure Coding System (HCPCS) Level II Code Modification Application Instructions for the 2020 Coding Cycle”.  

CMS appreciates the interest and engagement by innovators in working towards an electronic HCPCS code application submission system.  We would like to once again thank those who submitted electronic code applications as part of CMS’ demonstration in the 2019 HCPCS coding cycle.  These participants provided valuable feedback in terms of system readiness and user-friendliness, as well as recommendations for system improvements for broader implementation.  We also received general comments pertaining to electronic application submission via our “contact us” web site at HCPCS@cms.hhs.gov, overwhelmingly in favor of adoption of electronic submissions.  CMS learned a great deal from the demonstration and stakeholder comments, and we are translating our experience and stakeholder feedback into business requirements for an enhanced electronic application system with features that will enable efficient and accurate application submissions and processing.  While these system enhancements will not be ready for implementation in January 2020, we continue to work towards implementation of an electronic application system in a subsequent coding cycle.   


PUBLICATION OF 2020 HCPCS ANNUAL UPDATE

CMS is pleased to announce publication of its 2020 HCPCS Annual Update. This file has been posted to CMS’ HCPCS web site at /Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS

Note regarding coverage and payment indicators for codes in CMS’ 2020 HCPCS Update and DMEPOS Fee Schedule Files

If specific Medicare coverage or payment indicators or values have not been established for any new HCPCS codes, this may be because a national Medicare coverage determination and/or fee schedule amounts have not yet been established for these items.  This is neither an indicator of Medicare coverage or non-coverage.  In these cases, until national Medicare coverage and payment guidelines have been established for these codes, the Medicare coverage and payment determinations for these items may be made based on the discretion of the Medicare contractors processing claims for these items.


PUBLICATION OF HCPCS CODE APPLICATION AND DECISION DOCUMENTS RELATED TO 2020 UPDATE

Two additional companion documents to the Annual Update are available on CMS’ HCPCS web site at /Medicare/Coding/MedHCPCSGenInfo/index: 1) "CMS’ Level II HCPCS Coding Decisions for the 2019-2020 Coding Cycle", which is a spreadsheet including a sequential listing of CMS’ code applications, statement of request, CMS’ Preliminary HCPCS coding recommendation, and CMS’ Final HCPCS coding recommendation; and 2) a series of five narrative summary documents, one for each of the five HCPCS public meetings held in 2019. These summary documents include a narrative about each application, capturing the request topic and background summary, preliminary HCPCS coding recommendation, a summary of primary speaker comments, and CMS’ final HCPCS coding decision.


CHANGE IN HCPCS CODE DECISION NOTIFICATION PROCEDURE

As part of CMS’ ongoing efforts to improve transparency regarding Level II Healthcare Common Procedure Coding System (HCPCS) coding decisions and streamline our processes, CMS is implementing additional improvements to the issuance of HCPCS coding decisions.

Historically, CMS publishes the HCPCS Annual Update on CMS’ HCPCS web site at /Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS and also mailed written decision letters to individual applicants. In 2014, CMS began publishing a spreadsheet with the prior years of Level II coding decisions at the end of the coding cycle. In 2017, CMS added narrative statements for the prior years of Level II coding decisions, which provide additional detailed information, including the topic and background summary of every application; CMS’ published preliminary HCPCS coding recommendations; a summary of Primary Speaker comments at CMS’ HCPCS Public Meeting; and CMS’ final coding decisions. CMS received positive feedback from stakeholders regarding making this detailed information publicly available, along with requests to retain prior year coding information on our web site and add subsequent coding information toward development of a cumulative resource, instead of publishing current cycle information only. Accordingly, in early 2019, CMS created an intuitive online search feature to identify links to current and prior year’s publications, and restored previously published information from prior years.

Typically, the information in the narrative summary has also been included in HCPCS coding decision letters written by CMS and mailed to each individual applicant. To streamline our notification processes, effective for 2019-2020 HCPCS coding cycle, rather than issuing individual decision letters, CMS refers applicants and other stakeholders to the narrative summary and "Healthcare Common Procedure Coding System (HCPCS) Level II Coding Procedures" documents published at links above on our website.


The July 2019 HCPCS Quarterly Update has been revised and published on 09-27-2019 tore-revise code J0641; and to establish new code J0642. Both actions are effective October 1, 2019. The revised file has been posted to CMS’ HCPCS website at HCPCS Quarterly Update .


The following are the live stream YouTube URLS for the 2019 HCPCS Public Meetings:

Public YouTube URLs

2019 Jun 11th, HCPCS Public Meeting (Morning Session): https://www.youtube.com/watch?v=PPjRC84WeuY

2019 Jun 11th, HCPCS Public Meeting (Afternoon Session): https://www.youtube.com/watch?v=Xchi7LFMaBY

2019 Jun 12th, HCPCS Public Meeting (Morning Session): https://www.youtube.com/watch?v=33hbBaAdyvE

2019 Jun 12th, HCPCS Public Meeting (Afternoon Session): https://www.youtube.com/watch?v=1qNW-6U6dR8


The Centers for Medicare & Medicaid Services announces the release of a revised March 2019 Quarterly Update Chart for “Revised Other Codes Effective July 1, 2019”. The revised Quarterly HCPCS update includes new coding actions effective July 1, 2019, that were not included in the previously published file. The revised file has been posted to CMS’ HCPCS website at HCPCS Quarterly Update. The coding changes are effective on the date indicated in the update.


 

HCPCS Background Information

Each year, in the United States, health care insurers process over 5 billion claims for payment. For Medicare and other health insurance programs to ensure that these claims are processed in an orderly and consistent manner, standardized coding systems are essential. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA. Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.

Page Last Modified:
11/26/2019 08:30 PM