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December 6, 2016

2017 HCPCS Code Annual Update - Correct Coding - Correction

DME MAC Joint Publication

Originally Published December 1, 2016; Corrected December 6, 2016            

This is a correction to the December 1, 2016 publication. HCPCS codes were inadvertently left out. J7340 has been added to External Infusion Pumps, K0015 and K0070 have been added to Wheelchair Options/Accessories.

The following tables identify changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for 2017. The tables contain only the 2017 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, 2017.

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, 2016.

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, 2017.

There is no grace period that allows for submission of a discontinued code/modifier for claims with dates of service in 2017.

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 Orthosis

  Narrative Changes
Code New Narrative Old Narrative
L1906 ANKLE FOOT ORTHOSIS, MULTILIGAMENTOUS ANKLE SUPPORT, PREFABRICATED, OFF-THE-SHELF ANKLE FOOT ORTHOSIS, MULTILIGAMENTUS ANKLE SUPPORT, PREFABRICATED, OFF-THE-SHELF

Enteral Nutrition

  Discontinued Code
Code Narrative Crosswalk to Code
B9000 ENTERAL NUTRITION INFUSION PUMP - WITHOUT ALARM B9002
  Narrative Changes
Code New Narrative Old Narrative
B9002 ENTERAL NUTRITION INFUSION PUMP, ANY TYPE ENTERAL NUTRITION INFUSION PUMP - WITH ALARM

External Infusion Pumps

  Added Code
Code Narrative
A4224 SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATHETER, PER WEEK
A4225 SUPPLIES FOR EXTERNAL INSULIN INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH
  Narrative Changes
Code New Narrative Old Narrative
A4221 SUPPLIES FOR MAINTENANCE OF NON-INSULIN DRUG INFUSION CATHETER, PER WEEK (LIST DRUGS SEPARATELY) SUPPLIES FOR MAINTENANCE OF DRUG INFUSION CATHETER, PER WEEK (LIST DRUG SEPARATELY)
J7340 CARBIDOPA 5 MG/LEVODOPA 20 MG ENTERAL SUSPENSION, 100 ML CARBIDOPA 5 MG/LEVODOPA 20 MG ENTERAL SUSPENSION
K0552 SUPPLIES FOR EXTERNAL NON-INSULIN DRUG INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH

Knee Orthoses

  Added Code
Code Narrative
L1851 KNEE ORTHOSIS (KO), SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, PREFABRICATED, OFF-THE-SHELF
L1852 KNEE ORTHOSIS (KO), DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, PREFABRICATED, OFF-THE-SHELF
  Discontinued Code
Code Narrative Crosswalk to Code
K0901 KNEE ORTHOSIS (KO), SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, PREFABRICATED, OFF-THE-SHELF L1851
K0902 KNEE ORTHOSIS (KO), DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, PREFABRICATED, OFF-THE-SHELF L1852

Miscellaneous

  Added Code
Code Narrative
A4467 BELT, STRAP, SLEEVE, GARMENT, OR COVERING, ANY TYPE
A4553 NON-DISPOSABLE UNDERPADS, ALL SIZES
A9285 INVERSION/EVERSION CORRECTION DEVICE
A9286 HYGIENIC ITEM OR DEVICE, DISPOSABLE OR NON-DISPOSABLE, ANY TYPE, EACH
  Discontinued Code
Code Narrative Crosswalk to Code
A4466 GARMENT, BELT, SLEEVE OR OTHER COVERING, ELASTIC OR SIMILAR STRETCHABLE MATERIAL, ANY TYPE, EACH A4467

Neuromuscular Stimulators

  Narrative Changes
Code New Narrative Old Narrative
E0740 NON-IMPLANTED PELVIC FLOOR ELECTRICAL STIMULATOR, COMPLETE SYSTEM INCONTINENCE TREATMENT SYSTEM, PELVIC FLOOR STIMULATOR, MONITOR, SENSOR AND/OR TRAINER

Oral Antiemetic Drugs

  Added Code
Code Narrative
J8670 ROLAPITANT, ORAL, 1 MG
  Discontinued Code
Code Narrative Crosswalk to Code
Q9981 ROLAPITANT, ORAL, 1 MG J8670

Seat Lift Mechanisms

  Narrative Changes
Code New Narrative Old Narrative
E0627 SEAT LIFT MECHANISM, ELECTRIC, ANY TYPE SEAT LIFT MECHANISM INCORPORATED INTO A COMBINATION LIFT-CHAIR MECHANISM
E0629 SEAT LIFT MECHANISM, NON-ELECTRIC, ANY TYPE SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-NON-ELECTRIC
  Discontinued Code
Code Narrative Crosswalk to Code
E0628 SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-ELECTRIC E0627

Wheelchair Options/Accessories

  Narrative Changes
Code New Narrative Old Narrative
E0967 MANUAL WHEELCHAIR ACCESSORY, HAND RIM WITH PROJECTIONS, ANY TYPE, REPLACEMENT ONLY, EACH MANUAL WHEELCHAIR ACCESSORY, HAND RIM WITH PROJECTIONS, ANY TYPE, EACH
E0995 WHEELCHAIR ACCESSORY, CALF REST/PAD, REPLACEMENT ONLY, EACH WHEELCHAIR ACCESSORY, CALF REST/PAD, EACH
E2206 MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK ASSEMBLY, COMPLETE, REPLACEMENT ONLY, EACH MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK ASSEMBLY, COMPLETE, EACH
E2220 MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) PROPULSION TIRE, ANY SIZE, REPLACEMENT ONLY, EACH MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) PROPULSION TIRE, ANY SIZE, EACH
E2221 MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE), ANY SIZE, REPLACEMENT ONLY, EACH MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE), ANY SIZE, EACH
E2222 MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE WITH INTEGRATED WHEEL, ANY SIZE, REPLACEMENT ONLY, EACH MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE WITH INTEGRATED WHEEL, ANY SIZE, EACH
E2224 MANUAL WHEELCHAIR ACCESSORY, PROPULSION WHEEL EXCLUDES TIRE, ANY SIZE, REPLACEMENT ONLY, EACH MANUAL WHEELCHAIR ACCESSORY, PROPULSION WHEEL EXCLUDES TIRE, ANY SIZE, EACH
K0015 DETACHABLE, NON-ADJUSTABLE HEIGHT ARMREST, REPLACEMENT ONLY, EACH DETACHABLE, NON-ADJUSTABLE HEIGHT ARMREST, EACH
K0019 ARM PAD, REPLACEMENT ONLY, EACH ARM PAD, EACH
K0037 HIGH MOUNT FLIP-UP FOOTREST, REPLACEMENT ONLY, EACH HIGH MOUNT FLIP-UP FOOTREST, EACH
K0042 STANDARD SIZE FOOTPLATE, REPLACEMENT ONLY, EACH STANDARD SIZE FOOTPLATE, EACH
K0043 FOOTREST, LOWER EXTENSION TUBE, REPLACEMENT ONLY, EACH FOOTREST, LOWER EXTENSION TUBE, EACH
K0044 FOOTREST, UPPER HANGER BRACKET, REPLACEMENT ONLY, EACH FOOTREST, UPPER HANGER BRACKET, EACH
K0045 FOOTREST, COMPLETE ASSEMBLY, REPLACEMENT ONLY, EACH FOOTREST, COMPLETE ASSEMBLY
K0046 ELEVATING LEGREST, LOWER EXTENSION TUBE, REPLACEMENT ONLY, EACH ELEVATING LEGREST, LOWER EXTENSION TUBE, EACH
K0047 ELEVATING LEGREST, UPPER HANGER BRACKET, REPLACEMENT ONLY, EACH ELEVATING LEGREST, UPPER HANGER BRACKET, EACH
K0050 RATCHET ASSEMBLY, REPLACEMENT ONLY RATCHET ASSEMBLY
K0051 CAM RELEASE ASSEMBLY, FOOTREST OR LEGREST, REPLACEMENT ONLY, EACH CAM RELEASE ASSEMBLY, FOOTREST OR LEGREST, EACH
K0052 SWINGAWAY, DETACHABLE FOOTRESTS, REPLACEMENT ONLY, EACH SWINGAWAY, DETACHABLE FOOTRESTS, EACH
K0069 REAR WHEEL ASSEMBLY, COMPLETE, WITH SOLID TIRE, SPOKES OR MOLDED, REPLACEMENT ONLY, EACH REAR WHEEL ASSEMBLY, COMPLETE, WITH SOLID TIRE, SPOKES OR MOLDED, EACH
K0070 REAR WHEEL ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, SPOKES OR MOLDED, REPLACEMENT ONLY, EACH REAR WHEEL ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, SPOKES OR MOLDED, EACH
K0071 FRONT CASTER ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, REPLACEMENT ONLY, EACH FRONT CASTER ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, EACH
K0072 FRONT CASTER ASSEMBLY, COMPLETE, WITH SEMI-PNEUMATIC TIRE, REPLACEMENT ONLY, EACH FRONT CASTER ASSEMBLY, COMPLETE, WITH SEMI-PNEUMATIC TIRE, EACH
K0077 FRONT CASTER ASSEMBLY, COMPLETE, WITH SOLID TIRE, REPLACEMENT ONLY, EACH FRONT CASTER ASSEMBLY, COMPLETE, WITH SOLID TIRE, EACH
K0098 DRIVE BELT FOR POWER WHEELCHAIR, REPLACEMENT ONLY DRIVE BELT FOR POWER WHEELCHAIR

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