HCPCS Level II Coding Procedures

Anyone may submit a request to modify the HCPCS Level II national code set.

Add a new code: This could include requests to split an existing code category into its components or into subcategories.

Revise an existing code: When there's an existing code, you can make a request when you believe that the descriptor for the code needs to be revised to provide a better description of the category of products represented by the code.

Discontinue an existing code: When an existing code becomes obsolete or duplicate another code, you can  request to discontinue the code. This could include requests to combine existing codes.

• Drug and biological products: The first business day of each quarter (January, April, July, and October)
• Non-drug and non-biological items and services: The first business day of January and July

We'll consider applications that we get and determine to be complete by the deadline  for inclusion in that cycle. We'll consider applications we get after the deadline for a  subsequent coding cycle.

Visit MEARIS™ to submit a HCPCS Level II coding application.

HCPCS Level II is a system for identifying items and certain services. It isn't a methodology or system for making coverage or payment determinations, and the existence of a code doesn't, of itself, determine coverage or non-coverage for an item or service. While these codes are used for billing purposes, we make decisions about the addition, deletion, or revision of HCPCS Level II codes independent of the process for making determinations about coverage and payment.

We'll contact you through MEARIS™ if we need more information or clarification about your HCPCS Level II application. We'll also reach out if the HCPCS Level II pathway isn't the appropriate pathway.

Drug and biological products quarterly cycle: 

Non-drug and non-biological items and services biannual cycle: 

Typically, no.

Only during special circumstances and for specific products, CMS will allow the submission and consideration of HCPCS Level II applications outside of our established quarterly and biannual coding cycles. We'll allow off-cycle coding applications related to products needed in a National Emergency or a Public Health Emergency. We'll also  allow off-cycle coding applications related to anti-infective agents that address an urgent infectious or respiratory illness or disease. We would be informed by resources, like the NIAID classifications and the CDC’s NREVSS to guide those determinations.

If you disagree with CMS’ final HCPCS Level II coding decision, you may submit a new request in a subsequent coding cycle only if new information is available that we  didn't previously review. You can only submit a new application after we have posted our final determination.

Certain code set modification requests might require more extensive research to identify and analyze all the data pertinent to evaluating the proposed change to the HCPCS Level II code set. In that case, we may defer the request to a subsequent coding cycle. In certain circumstances, we may have a final determination that requests specific information from you. In this case, you can reach out to us at HCPCS@cms.hhs.gov to provide the requested information. 

If you believe your product falls into an existing HCPCS Level II code (for example, durable medical equipment, prosthetics, orthotics, and other supplies), the Medicare contractor, Pricing, Coding Analysis, and Coding (PDAC), handles code verification requests. Learn more about PDAC code verification.

Review the Frequently Asked Questions for Single Source Drugs and Biologicals (PDF).

The code application procedures for changes to HCPCS Level II C and G codes differs from the typical HCPCS Level II application process described above. 

C codes:

• The C codes (pass-through) were established to permit implementation of section 201 of the Balanced Budget Refinement Act of 1999. HCPCS Level II C codes are utilized to report drugs, biologicals, magnetic resonance angiography (MRA), and devices used for CMS’ Medicare Hospital Outpatient Prospective Payment System (HOPPS).
• For information about the HOPPS pass-through process, visit the HOPPS website.

G codes:

• The G codes are used to identify professional health care procedures and services that would otherwise be coded in CPT®-4 (the current version of CPT® codes) but for which there are no CPT®-4 codes
• CMS doesn't have an application process for G codes, as they're established internally by CMS to support Medicare claims processing needs
• As G codes are part of the national HCPCS Level II code set, they may also be used by non-Medicare insurers