March 11, 2025
April 2025 HCPCS Updates – New, Revised, and Discontinued HCPCS Codes and Modifiers
The following information is based on the April 2025 Healthcare Common Procedure Coding System (HCPCS) file. There are several updates that will be effective April 1, 2025. Please keep in mind that the appearance of a HCPCS code is not an indication of coverage by the DME MAC.
This following list contains added HCPCS codes that will be effective April 1, 2025.
HCPCS | DESCRIPTION |
---|---|
A6515 | Gradient compression wrap with adjustable straps, full leg, each, custom |
A6516 | Gradient compression wrap with adjustable straps, foot, each, custom |
A6517 | Gradient compression wrap with adjustable straps, below knee, each, custom |
A6518 | Gradient compression wrap with adjustable straps, arm, each, custom |
A6519 | Gradient compression garment, not otherwise specified, for nighttime use, each |
A6611 | Gradient compression wrap with adjustable straps, above knee, each, custom |
A9154 | Artificial saliva, 1 ml |
E0201 | Penile contracture device, manual, greater than 3 lbs. traction force |
E1022 | Wheelchair transportation securement system, any type includes all components and accessories |
E1023 | Wheelchair transit securement system, includes all components and accessories |
E1032 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware used with joystick or other drive control interface |
E1033 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for headrest, cushioned, any type |
E1034 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral trunk or hip support, any type |
E1832 | Static progressive stretch finger device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
J0281 | Injection, aminocaproic acid, 1 gram |
J1072 | Injection, testosterone cypionate (azmiro), 1 mg |
J1271 | Injection, doxycycline hyclate, 1 mg |
J1299 | Injection, eculizumab, 2 mg |
J1308 | Injection, famotidine, 0.25 mg |
J1808 | Injection, folic acid, 0.1 mg |
J1938 | Injection, furosemide, 1 mg |
J2351 | Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq |
J2428 | Injection, paliperidone palmitate extended release (erzofri), 1 mg |
J2804 | Injection, rifampin, 1 mg |
J2865 | Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg |
J7521 | Tacrolimus, granules, oral suspension, 0.1 mg |
J9024 | Injection, atezolizumab, 5 mg and hyaluronidase-tqjs |
J9038 | Injection, axatilimab-csfr, 0.1 mg |
J9054 | Injection, bortezomib (boruzu), 0.1 mg |
J9161 | Injection, denileukin diftitox-cxdl, 1 mcg |
L0720 | Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
L1933 | Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf |
L1952 | Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, off-the-shelf |
L5827 | Endoskeletal knee-shin system, single axis, electromechanical swing and stance phase control, with or without shock absorption and stance extension damping |
L6028 | Partial hand including fingers, flexible or non-flexible interface, endoskeletal system, molded to patient model, for use without external power, not including inserts described by L6692 |
L6029 | Upper extremity addition, test socket/interface, partial hand including fingers |
L6030 | Upper extremity addition, external frame, partial hand including fingers |
L6031 | Replacement socket/interface, partial hand including fingers, molded to patient model, for use with or without external power |
L6032 | Addition to upper extremity prosthesis, partial hand including fingers, ultralight material (titanium, carbon fiber or equal) |
L6033 | Addition to upper extremity prosthesis, partial hand including fingers, acrylic material |
L6037 | Immediate post-surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, partial hand including fingers |
L6700 | Upper extremity addition, external powered feature, myoelectronic control module, additional emg inputs, pattern-recognition decoding intent movement |
L7406 | Addition to upper extremity, user adjustable, mechanical, residual limb volume management system |
L1006 | Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla to trochanter, includes all accessory pads, straps and interface, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
L1653 | Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, off the shelf |
L1821 | Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf |
L8720 | External lower extremity sensory prosthesis, cutaneous stimulation of mechanoreceptors proximal to the ankle, per leg |
L8721 | Receptor sole for use with L8720, replacement, each |
Q5147 | Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg |
Q5148 | Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram |
Q5149 | Injection, aflibercept-abzv (enzeevu), biosimilar, 1 mg |
Q5150 | Injection, aflibercept-mrbb (ahzantive), biosimilar, 1 mg |
Q5151 | Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg |
Q5152 | Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg |
The following HCPCS codes have description/verbiage changes that will be effective April 1, 2025.
HCPCS | DESCRIPTION |
---|---|
A4453 | Rectal catheter with or without balloon, for use with any type transanal irrigation system, each |
A4459 | Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type |
A6549 | Gradient compression garment, not otherwise specified, for daytime use, each |
A6583 | Gradient compression wrap with adjustable straps, below knee, each |
A6585 | Gradient compression wrap with adjustable straps, above knee, each |
A6586 | Gradient compression wrap with adjustable straps, full leg, each |
A6587 | Gradient compression wrap with adjustable straps, foot, each |
A6588 | Gradient compression wrap with adjustable straps, arm, each |
E1005 | Wheelchair accessory, power seating system, recline only, with power shear reduction |
E1028 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
E1801 | Static progressive stretch/patient actualized serial stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
E1811 | Static progressive stretch/patient actualized serial stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
E1816 | Static progressive stretch/patient actualized serial stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories |
E1818 | Static progressive stretch/patient actualized serial stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories |
E1841 | Static progressive stretch/patient actualized serial stretch shoulder device, with or without range of motion adjustment, includes all components and accessories |
J9073 | Injection, cyclophosphamide (dr. reddy's), 5 mg |
L1932 | Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
L1951 | Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
L1971 | Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
L6692 | Upper extremity addition, silicone gel insert or equal, with or without locking mechanism, each |
L6698 | Addition to upper extremity prosthesis, lock mechanism, excludes socket insert |
The following listing contains discontinued HCPCS codes, along with the cross-walked HCPCS codes (if applicable). Please note, not all discontinued HCPCS codes will have a cross-walked HCPCS code.
HCPCS | DISCONTINUE DATE | CROSSWALK HCPCS CODE |
---|---|---|
J1094 | 03/31/2025 | |
J1300 | 03/31/2025 | |
J1810 | 03/31/2025 | |
J1890 | 03/31/2025 | |
J1940 | 03/31/2025 | |
J9037 | 03/31/2025 | |
J9247 | 03/31/2025 | |
L8010 | 03/31/2025 | |
Q5139 | 03/31/2025 |