HCPCS - General Information
CMS June 1, 2020 and June 2, 2020 HCPCS Public Meetings - WebEx links for remote participation:
Individual WebEx links for remote participation in CMS June 1, 2020 and June 2, 2020 HCPCS Public Meetings were e-mailed directly to registered primary speakers and registered 5-minute speakers. Prior registration (now closed), was necessary in order for speakers to receive their unique WebEx dial-in links.
There are also General Attendee links for use by persons planning to attend and listen-only. These links are provided in CMS “2020 Guidelines for Participation in Virtual Public Meetings for New Public Requests for Revisions to the Healthcare Common Procedure Coding System (HCPCS)”. The guidelines include two separate General Attendee links, one for the June 1, 2020 meeting; and different one for the June 2, 2020 meeting. These guidelines can be viewed and downloaded at https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSPublicMeetings
The General Attendee links and passwords, and dial-in information for each meeting are also provided below:
General Attendee link for June 1st 2020:
Dial in Toll Free Number: 1-855-829-8848
Webinar ID: 160 555 9649
General Attendee link for June 2nd 2020:
Dial in Toll Free Number: 1-855-829-8848
Webinar ID: 160 884 0044
Attendance via the general attendee link offers a feature for asking questions and making comments. The General Attendee links have changed since we originally published our guidelines documents (as mentioned above). Our published guidelines have been updated to include the correct General Attendee links.
CMS is pleased to announce publication of its HCPCS Public Meeting Agendas for its June 1st and June 2nd 2020 Virtual HCPCS Public Meetings for Durable Medical Equipment (DME) and Accessories; Orthotics and Prosthetics (O & P); Supplies and Other Non-Drug and Non-Biological items and services. The agendas can be viewed and downloaded at: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSPublicMeetings
Due to the COVID-19 Public Health Emergency and related restrictions on public gatherings, our June 2020 HCPCS Public Meetings will be held virtually via WebEx, for remote attendance only.
For the June 2, 2020 Public meeting only, in addition to information pertaining to current applications for DMEPOS and other non-drug and non-biological items; CMS is also including information pertaining to a previous HCPCS code application which resulted in the establishment of code E0787 (External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing) and related supply code A4226, as we are interested in gathering additional input pertaining to use of that code. Please refer to the June 2, 2020 HCPCS Public Meeting agenda for additional information.
CMS is also announcing publication of CMS “2020 GUIDELINES FOR PARTICIPATION IN VIRTUAL PUBLIC MEETINGS FOR NEW PUBLIC REQUESTS FOR REVISIONS TO THE HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)”. These guidelines can also be viewed and downloaded at: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSPublicMeetings
These guidelines contain important and useful information such as instructions for registering to attend public meetings; separate instructions for registering as a primary speaker or a 5-minute speaker; guidelines for participation in public meetings; deadlines for registration and materials submission; and helpful tips for a productive meeting.
Individual WebEx links for attending the public meetings will be e-mailed directly to registered primary speakers and registered 5-minute speakers. All speakers must register online, identify as a primary or 5-minute speaker, and provide the requested contact information at: https://www.cms.gov/apps/events/event.asp?id=3750. This registration link will be open when this notice is published. Registration is necessary in order for speakers to receive their unique WebEx dial-in link.
The general attendee link, for use by persons planning to attend and listen-only, is provided in the Guidelines for Participation (as above). Attendance via the general attendee link offers a feature for asking questions and making comments.
We are extending our public meeting registration deadline and also Primary Speaker’s materials deadline from May 14, 2020, as previously published in our Public Meeting Federal Register notice, to May 21, 2020.
The April 2020 HCPCS 2020 HCPCS Application Summary for Quarter 1 2020 Drugs and Biologicals has been revised and published on 04-14-2020 to correct code for Request 20.053 which should be Q4245. Actions are effective July 1, 2020. The revised file has been posted to CMS’ HCPCS website at Current/Prior Years CMS HCPCS Level II Coding Decisions: Narrative Summary
PUBLICATION OF CMS HCPCS LEVEL II CODE DECISIONS FOR FIRST QUARTER (Q1), 2020 APPLICATION CYCLE FOR DRUG AND BIOLOGICAL PRODUCTS
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. CMS has implemented 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 part of our comprehensive initiative to foster innovation and expedite adoption of and patient access to new medical technologies.
CMS is pleased to announce publication of its 2020 HCPCS Application Summary for Q1 2020 Drugs and Biologicals at: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Prior-Years-CMS-HCPCS-LevelII-Coding-Decisions-Narrative-Summary
This narrative summary document includes a sequential listing of applications for HCPCS codes for drug and biological products submitted to CMS’ first quarterly coding of 2020 (Q1 2020). For each application, the following information is provided: a statement of the incoming request; a summary of the applicant’s request; and CMS’ coding decision.
Please continue to monitor this web site for CMS July 2020 HCPCS Update file, which will be published separately, in the coming weeks, at: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS
ANNOUNCEMENT RE: E-MAIL SUBMISSION OF NEW HCPCS CODE APPLICATIONS (PDF) FOR APRIL 6, 2020 DEADLINE FOR 2ND 2020 QUARTERLY CYCLE FOR DRUGS AND BIOLOGICALS; AND SUBMISSION OF SUPPLEMENTAL AND PUBLIC MEETING MATERIALS FOR OUR 1ST 2020 BIANNUAL DMEPOS CODING CYCLE.
CMS has modified its HCPCS Level II code application submission procedures as part of our response to the national emergency declared in the United States on March 13, 2020 related to the COVID-19 Outbreak. CMS plans to timely accept and process HCPCS code applications for drug and biological products for the 2nd Quarterly coding cycle in 2020, beginning April 6, 2020.
To accommodate limited on-site presence at CMS to receive and process paper package, and limitations on our applicant’s ability to package and ship applications; we established a new mailbox and secure mechanism to electronically submit new applications to CMS.
Please electronically submit all HCPCS code requests for the 2nd Quarter, 2020 coding cycle for drugs and biological products to our new mailbox, implemented for this purpose, using the following instructions:
- Create a PDF document, both Word and Libre Office will save documents as PDF files
- The files must be zipped with a passphrase with AES 256 encryption if they contain any proprietary or personally identifiable information
- In PKZip, set the security options to AES 256 passphrase. 7Zip can also be used to encrypt the zip files using AES 256 passphrase
- Enter the passphrase in the dialogue box to encrypt the files
- Attachments must be less than 100M. Split size will create multi part zip files which can be sent in separate messages
- Send the passphrase in a separate email from the zip files to the email address below
- The applications should be emailed to : HCPCS_Level_II_code_applications@cms.hhs.gov (Deadline: 11:59 PM Eastern on April 6, 2020)
- The e-mail box (above) may also be used to notify CMS staff of problems with electronic application submissions. Staff will be available to respond during normal business hours
- CMS staff will e-mail confirmation of applications received.
We appreciate your patience and perseverance in the face of this national emergency. Please continue to monitor this web site for further information or procedural changes as the situation evolves.
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 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.