HCPCS - General Information

What's New

09/26/2022

PUBLICATION OF CODING DECISIONS AND MEDICARE BENEFIT CATEGORY & PAYMENT DETERMINATIONS FOR B1 2022 HCPCS LEVEL II NON-DRUG AND NON-BIOLOGICAL ITEMS AND SERVICES APPLICATIONS

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce publication of its Healthcare Common Procedure Coding System (HCPCS) Application Summaries, Coding Decisions and Benefit Category & Payment Determinations for the first bi-annual (B1) 2022 Non-Drug and Non-Biological Items and Services at: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Prior-Years-CMS-HCPCS-LevelII-Coding-Decisions-Narrative-Summary.

This narrative summary document includes the B1 2022 HCPCS Level II applications for non-drug and non-biological items and services coding requests. For each application, the following information is provided:

  • a statement of the topic/issue;
  • a summary of the applicant’s request;
  • CMS’ preliminary coding recommendation;
  • CMS’ preliminary Medicare benefit category determination;
  • CMS’ preliminary Medicare payment determination;
  • Summary of public feedback;
  • CMS’ final HCPCS coding decision;
  • Final Medicare benefit category determination; and
  • Final Medicare payment determination.

Please continue to monitor this web site for CMS’ October 2022 HCPCS Update file, which will be published separately in the coming weeks, at: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update.
 

HCPCS PUBLIC MEETING MATERIALS

CMS is announcing the publication of its First Biannual (B1) 2022 HCPCS Public Meeting Agendas for its June 7-10 2022, Virtual HCPCS Public Meeting. The agendas are available at: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSPublicMeetings

CMS recommends interested parties refer to the Guidelines for Participation in HCPCS Public Meetings for June 2022, which are available at: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSPublicMeetings.

The guidelines contain important and useful information, such as instructions for registering to attend the B1 2022 HCPCS Public Meeting; instructions for registering as a primary speaker or a 5-minute speaker; deadlines for registration and materials submission; and tips for helping CMS conduct a productive meeting.

The deadline to register as a speaker is Tuesday, May 24, 2022, at 5:00 p.m., eastern daylight time (e.d.t.). All speakers must register online, identify as a primary speaker or a 5-minute speaker, and provide the requested contact information at: https://cms.zoomgov.com/meeting/register/vJIsd-mgpz4jEvObPtTKB0-BGiFBQ80CuHQ. Primary speakers are permitted to submit written presentation materials, which are also due no later than Tuesday, May 24, 2022, at 5:00 p.m., e.d.t.

Additionally, CMS notes that the B1 2022 HCPCS Public Meeting on June 7-10 will include preliminary benefit category and payment determinations for codes effective January 1, 2020 to April 1, 2022, continuous glucose monitoring coding and payment determinations, and additional items added by CMS to address Medicare benefit category or payment determinations. 

Important HCPCS Announcements

09/15/2022                           

ANNOUNCEMENT OF HCPCS LEVEL II SUBMISSION DEADLINES

Beginning in 2023, HCPCS Level II application submission deadlines will align with the first business day of each quarter (January, April, July and October) for drugs and biological product applications and the first business day of January and July for non-drug and non-biological items and services applications. Please visit the MEARIS™ homepage or the MEARIS™ HCPCS Level II Resources page for specific HCPCS Level II application deadlines.

PUBLICATION OF CODING DECISIONS FOR Q2 2022 HCPCS LEVEL II DRUG and BIOLOGICAL APPLICATIONS

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce publication of its Healthcare Common Procedure Coding System (HCPCS) Application Summaries and Coding Decisions for quarter two (Q2) 2022 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 the Q2 2022 HCPCS Level II applications for drug and biological coding requests. For each application, the following information is provided:

  • a statement of the topic/issue;
  • a summary of the applicant’s request; and
  • CMS’ coding decision.

Please continue to monitor this web site for CMS’ October 2022 HCPCS Update file, which will be published separately in the coming weeks, at: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update.

HCPCS Webpage Updates

As all HCPCS Level II updates are now fully searchable and sortable electronic files, CMS will no longer publish the Table of Drugs and HCPCS Index as part of the HCPCS quarterly updates.

Additionally, due to the establishment of complete HCPCS quarterly files beginning in 2020, CMS is removing the “Other Codes (other than C and G HCPCS codes)” section from the HCPCS Quarterly Update page. The information contained in this section has been incorporated into annual HCPCS file for the appropriate year.

PUBLIC NOTIFICATION OF NEW HCPCS LEVEL II APPLICATION SUBMISSION PROCESS

The electronic application intake system, Medicare Electronic Application Request Information System (MEARISTM), is available for HCPCS Level II Q4 2021 and B1 2022 application submissions, with application submissions due no later than September 20, 2021 and January 4, 2022, respectively. The HCPCS Level II Application form designed for MEARISTM is similar to the current OMB-approved paper application (CMS-10224, OMB-0938-1042). The CMS HCPCS Level II Modification to Code Set Form can be accessed at: https://mearis.cms.gov/public/home.

Moving forward, CMS will only accept HCPCS Level II applications submitted via MEARISTM. Applications submitted through the HCPCS application mailbox will no longer be considered. Within MEARISTM, we have built in several resources to support applicants:

  • Please refer to the “Resources” section for guidance regarding the application submission process at: https://mearis.cms.gov/public/resources.
  • Technical support is available under “Useful Links” at the bottom of the MEARISTM
  • Application related questions can be submitted to CMS using the form available under “Contact” at: https://mearis.cms.gov/public/resources?app=HCPCS.
  • The time required for application submission, including the time needed to gather relevant information as well as to complete the form, is estimated to be roughly around 10 hours per submission. Applicants are, therefore, encouraged to start in advance of the due date to ensure adequate time for submission.

Application submission through MEARISTM will not only help CMS track applications and streamline the review process, but it will also create efficiencies for applicants when compared to the previous paper submission 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.

Page Last Modified:
09/27/2022 02:08 PM