Skip to main content
Corporate
CGS Administrators, LLC

IVR: 866.238.9650 Customer Service and myCGS: 866.270.4909

December 3, 2015

2016 HCPCS Code Annual Update - Correct Coding

DME MAC Joint Publication

The following tables identify changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for 2016. The tables contain only the 2016 HCPCS codes that are applicable to items that fall within Medicare DME MAC jurisdiction. There may be other HCPCS code changes for items under the jurisdiction of other Medicare contractors. Consult with those contractors for information regarding HCPCS codes that fall within their areas of responsibility.

All HCPCS code changes are effective for claims with dates of service on or after January 1, 2016.

CODE CHANGE CATEGORIES

Added Codes/Added Modifiers: These are new codes and modifiers.

Discontinued Codes/Deleted Modifiers: These are codes and modifiers that are discontinued /deleted. These codes and modifiers continue to be valid for Medicare claims with dates of service on or before December 31, 2015.

If there is a direct crosswalk for a discontinued/deleted code or modifier, the crosswalk code is listed in the table. The crosswalked codes are effective for claims with dates of service on or after January 1, 2016.

There is no grace period that allows for submission of a discontinued code/modifier for claims with dates of service in 2016.

Narrative Changes/Revised Modifiers: These are changes in the narrative descriptor for an existing code or modifier.

For products not listed on the DMECS Product Classification Lists, suppliers should evaluate whether a revised narrative changes their coding choices.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/External Website

CODE TABLES

The appearance of a code in the tables below does not necessarily indicate coverage.  Refer to the applicable Local Coverage Determination for information regarding Medicare reimbursement requirements.

Ankle-Foot/Knee-Ankle-Foot OrthosisExternal Website

 

Narrative Changes

Code

Old Narrative

New Narrative

L1902

ANKLE FOOT ORTHOSIS, ANKLE GAUNTLET, PREFABRICATED, OFF-THE-SHELF

ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILIAR, WITH OR WITHOUT JOINTS, PREFABRICATED, OFF-THE-SHELF

L1904

ANKLE ORTHOSIS, ANKLE GAUNTLET, CUSTOM-FABRICATED

ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILIAR, WITH OR WITHOUT JOINTS, CUSTOM FABRICATED

Bowel ManagementExternal Website

 

Added Code

Code

Narrative

A4337

INCONTINENCE SUPPLY, RECTAL INSERT, ANY TYPE, EACH

External Infusion PumpsExternal Website

 

Added Code

Code

Narrative

J7340

CARBIDOPA 5 MG/LEVODOPA 20 MG ENTERAL SUSPENSION

J9039

INJECTION, BLINATUMOMAB, 1 MICROGRAM

J1575

INJECTION, IMMUNE GLOBULIN/HYALURONIDASE, (HYQVIA), 100 MG IMMUNEGLOBULIN

Immunosuppressive DrugsExternal Website

 

Added Code

Code

Narrative

J7503

TACROLIMUS, EXTENDED RELEASE, (ENVARSUS XR), ORAL, 0.25 MG

J7512

PREDNISONE, IMMEDIATE RELEASE OR DELAYED RELEASE, ORAL, 1 MG

 

Narrative Changes

Code

Old Narrative

New Narrative

J7508

TACROLIMUS, EXTENDED RELEASE, ORAL, 0.1 MG

TACROLIMUS, EXTENDED RELEASE, (ASTAGRAF XL), ORAL, 0.1 MG

 

Discontinued Code

Code

Narrative

Crosswalk to Code

J7506

PREDNISONE, ORAL, PER 5 MG

J7512

Miscellaneous

 

Added Code

Code

Narrative

J7999

COMPOUNDED DRUG, NOT OTHERWISE CLASSIFIED

 

Discontinued Code

Code

Narrative

Crosswalk to Code

Q9977

COMPOUNDED DRUG, NOT OTHERWISE CLASSIFIED

J7999 

NebulizersExternal Website

 

Discontinued Code

Code

Narrative

Crosswalk to Code

A7011

CORRUGATED TUBING, NON-DISPOSABLE, USED WITH LARGE VOLUME NEBULIZER, 10 FEET

NONE

Oral Antiemetic DrugsExternal Website

 

Added Code

Code

Narrative

J8655

NETUPITANT 300 MG AND PALONOSETRON 0.5 MG

 

Discontinued Code

Code

Narrative

Crosswalk to Code

Q9978

NETUPITANT 300 MG AND PALONOSETRON 0.5 MG

J8655

Parenteral NutritionExternal Website

 

Narrative Changes

Code

Old Narrative

New Narrative

B5000

PARENTERAL NUTRITION SOLUTION:  COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, RENAL - AMIROSYN RF, NEPHRAMINE, RENAMINE - PREMIX

PARENTERAL NUTRITION SOLUTION COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, RENAL-AMINOSYN-RF, NEPHRAMINE, RENAMINE-PREMIX

B5100

PARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, HEPATIC - FREAMINE HBC, HEPATAMINE - PREMIX

PARENTERAL NUTRITION SOLUTION COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, HEPATIC, HEPATAMINE-PREMIX

B5200

PARENTERAL NUTRITION SOLUTION:  COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, STRESS - BRANCH CHAIN AMINO ACIDS - PREMIX

PARENTERAL NUTRITION SOLUTION COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, STRESS-BRANCH CHAIN AMINO ACIDS-FREAMINE-HBC-PREMIX

VentilatorsExternal Website

 

Added Code

Code

Narrative

E0465

HOME VENTILATOR, ANY TYPE, USED WITH INVASIVE INTERFACE, (E.G., TRACHEOSTOMY TUBE)

E0466

HOME VENTILATOR, ANY TYPE, USED WITH NON-INVASIVE INTERFACE, (E.G., MASK, CHEST SHELL)

 

Discontinued Code

Code

Narrative

Crosswalk to Code

E0450

VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE CONTROL MODE, USED WITH INVASIVE INTERFACE (E.G., TRACHEOSTOMY TUBE)

E0465

E0460

NEGATIVE PRESSURE VENTILATOR; PORTABLE OR STATIONARY

E0466

E0461

VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE CONTROL MODE, USED WITH NON-INVASIVE INTERFACE (E.G., MASK)

E0466

E0463

PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE CONTROL MODE, USED WITH INVASIVE INTERFACE (E.G., TRACHEOSTOMY TUBE)

E0465

E0464

PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE CONTROL MODE, USED WITH NON-INVASIVE INTERFACE (E.G., MASK)

E0466

Wheelchair Options/AccessoriesExternal Website

 

Added Code

Code

Narrative

E1012

WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, CENTER MOUNT POWER ELEVATING LEG REST/PLATFORM, COMPLETE SYSTEM, ANY TYPE, EACH

 

Narrative Changes

Code

Old Narrative

New Narrative

K0017

DETACHABLE, ADJUSTABLE HEIGHT ARMREST, BASE, EACH

DETACHABLE, ADJUSTABLE HEIGHT ARMREST, BASE, REPLACEMENT ONLY, EACH

K0018

DETACHABLE, ADJUSTABLE HEIGHT ARMREST, UPPER PORTION, EACH

DETACHABLE, ADJUSTABLE HEIGHT ARMREST, UPPER PORTION, REPLACEMENT ONLY, EACH

Two Vantage Way, Nashville, TN 37228 © CGS Administrators, LLC. All Rights Reserved