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HCPCS - General Information

What's New

WebEx Links to Tuesday, May 14, 2019 HCPCS Public Meeting were CORRECTED on Monday, May 13, 2019.  If you have previously accessed this information, access again to get the CORRECTED LINKS to participate in the Tuesday, May 14, 2019 HCPCS Public Meeting.


WEBEX Links and Instructions for Remote Participation in CMS HCPCS Public Meetings for Drugs, Biological, and Radiopharmaceuticals on May 13, 14 and 15, 2019

Note that there are two separate Links to join remotely for each meeting date:

If you are pre-registered with CMS to be a primary speaker or a 5-minute speaker for one or more of the meeting dates listed above, you are a designated “PANELIST” and must use the panelist link and instructions to join the meeting, in order to be able to provide your presentation and also to offer comments during the “questions and comments” portions of the meeting.

All other attendees must use the “ATTENDEE” Link and instructions in order to have the capability to offer comments verbally and/or via chat box during question and comment portions for every agenda item throughout the meeting.

*** ALL pre-registered primary and 5-minute speakers participating remotely must use the PANELIST Link listed below and join the call 30-45 minutes prior to the meeting 9:00 am start time. Individuals joining as attendees may join at 9:00am Thank You***


CMS is pleased to announce that all interested parties not attending the HCPCS Public Meetings in person can Live Stream on YouTube.

The Public URLs for May 13, 14 and May 15, 2019, are listed below for each of these meetings.

2019 May 13th, HCPCS Public Meeting (Morning Session) https://www.youtube.com/watch?v=4_RUVMGXr3s

2019 May 14th, HCPCS Public Meeting (Morning Session) https://www.youtube.com/watch?v=Y9u-mnXzWak

2019 May 15th, HCPCS Public Meeting (Morning Session) https://www.youtube.com/watch?v=3TLzeXiPU2k

2019 May 15th, HCPCS Public Meeting (Afternoon Session) https://www.youtube.com/watch?v=XMPch30MtIo


As CMS is late in publishing the May 13th, May 14th, and May 15th 2019 HCPCS Public Meeting agendas, we have extended our public meeting registration deadline and also our materials deadline from April 29, 2019 to May 6, 2019. In addition the online registration for the above public meetings is now open at https://www.cms.gov/apps/events/event.asp?id=3743.


CMS is pleased to announce publication of its "2019 Guidelines for Participation in HCPCS Public Meetings" together with HCPCS Public Meeting Agendas for its May 13th, May 14th, and May 15th, 2019 HCPCS Public Meetings for Drugs, biologicals and radiopharmaceuticals.

Note that the agenda for the May 13th meeting was published earlier this week, and has been revised to include one additional item. As CMS is late in publishing these agendas, we have extended our public meeting registration deadline and also our materials deadline from April 29, 2019 to May 6, 2019.

We are also pleased to announce that CMS has added the capability for remote participation (including primary speaker presentations and 5-minute speakers) for our HCPCS Public Meetings this year. We hope this new opportunity will increase transparency, expand participation in our Public Meetings; obviate the need to travel to participate in-person at Public Meetings; and make participation logistically easier, less expensive and less time-consuming. Please refer to our updated “2019 Guidelines for Participation in HCPCS Public Meetings” for separate instructions for registering to participate remotely.

Applicants are not required to attend our public meetings or to comment on CMS’ published preliminary HCPCS coding recommendations. Applicants and others who wish to provide comments pertaining to CMS’ published preliminary HCPCS code recommendations may do so by attending our Public Meetings in person; participating remotely in our Public Meetings; or submitting written comments as directed in our “2019 Guidelines for Participation in HCPCS Public Meetings” by close-of-business on the date of the public meeting at which the particular application is discussed. CMS will also livestream its HCPCS Public Meetings on YouTube. Please visit https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSPublicMeetings.html for more information.


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.


Notification of Change in Medicare Coverage and Pricing Indicators for HCPCS Codes Q9994 and B4105 for In-Line Cartridge Containing Digestive Enzymes(s) for Enteral Feeding, Each

Effective December 3, 2018, the Medicare coverage indicator for HCPCS code Q9994 is changed from D “Special Coverage Instructions Apply” to C “Contractor Discretion,” and the Medicare pricing indicator for HCPCS code Q9994 is changed from 00 “Service Not Separately Priced by Part B” to 39 “Parenteral and Enteral Nutrition.”

Effective January 1, 2019, the Medicare coverage indicator for HCPCS code B4105 is changed from D “Special Coverage Instructions Apply” to C “Contractor Discretion,” and the Medicare pricing indicator for HCPCS code B4105 is changed from 00 “Service Not Separately Priced by Part B” to 39 “Parenteral and Enteral Nutrition.”

Code B4105 replaces code Q9994 effective for claims with dates of service on or after January 1, 2019.


CMS announces changes to the Healthcare Common Procedure Coding System (HCPCS) Process for 2019. HCPCS Level II Coding Process.


 

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.