December 3, 2009
2010 HCPCS Updates – New, Discontinued and Verbiage Changes
New HCPCS Codes
The following new codes are effective for dates of service on or after January 1, 2010. If billed before January 1, 2010, the code will be returned as unprocessable or denied as an invalid code. The appearance of a HCPCS code in the list below does not necessarily indicate coverage.
| HCPCS Code | Description |
|---|---|
| A4336 | INCONTINENCE SUPPLY, URETHRAL INSERT, ANY TYPE, EACH |
| A4360 | DISPOSABLE EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE, WITH PAD AND /OR POUCH, EACH |
| A4456 | ADHESIVE REMOVER, WIPES, ANY TYPE, EACH |
| A4466 | GARMENT, BELT, SLEEVE OR OTHER COVERING, ELASTIC OR SIMILAR STRETCHABLE MATERIAL, ANY TYPE, EACH |
| E0433 | PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; HOME LIQUEFIER USED TO FILL PORTABLE LIQUID OXYGEN CONTAINERS, INCLUDES PORTABLE CONTAINERS, REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA OR MASK AND TUBING, WITH OR WITHOUT SUPPLY RESERVOIR AND CONTENTS GAUGE |
| E1036 | MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, EXTRA- WIDE, WITH INTEGRATED SEAT, OPERATED BY CAREGIVER, PATIENT WEIGHT CAPACITY GREATER THAN 300 LBS |
| J0461 | INJECTION, ATROPINE SULFATE, 0.01 MG |
| J0559 | INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 2500 UNITS |
| J0586 | INJECTION, ABOBOTULINUMTOXINA, 5 UNITS |
| J0598 | INJECTION, C1 ESTERASE INHIBITOR (HUMAN), 10 UNITS |
| J0718 | INJECTION, CERTOLIZUMAB PEGOL, 1 MG |
| J0833 | INJECTION, COSYNTROPIN, NOT OTHERWISE SPECIFIED, 0.25 MG |
| J0834 | INJECTION, COSYNTROPIN (CORTROSYN), 0.25 MG |
| J1680 | INJECTION, HUMAN FIBRINOGEN CONCENTRATE, 100 MG |
| J2562 | INJECTION, PLERIXAFOR, 1 MG |
| J2793 | INJECTION, RILONACEPT, 1 MG |
| J2796 | INJECTION, ROMIPLOSTIM, 10 MICROGRAMS |
| J7185 | INJECTION, FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) (XYNTHA), PER I.U. |
| J7325 | HYALURONAN OR DERIVATIVE, SYNVISC OR SYNVISC- ONE, FOR INTRA-ARTICULAR INJECTION, 1 MG |
| J9155 | INJECTION, DEGARELIX, 1 MG |
| J9171 | INJECTION, DOCETAXEL, 1 MG |
| J9328 | INJECTION, TEMOZOLOMIDE, 1 MG |
| L2861 | ADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE, CONCENTRIC ADJUSTABLE TORSION STYLE MECHANISM FOR CUSTOM FABRICATED ORTHOTICS ONLY, EACH |
| L3891 | ADDITION TO UPPER EXTREMITY JOINT, WRIST OR ELBOW, CONCENTRIC ADJUSTABLE TORSION STYLE MECHANISM FOR CUSTOM FABRICATED ORTHOTICS ONLY, EACH |
| L5973 | ENDOSKELETAL ANKLE FOOT SYSTEM, MICROPROCESSOR CONTROLLED FEATURE, DORSIFLEXION AND /OR PLANTAR FLEXION CONTROL, INCLUDES POWER SOURCE |
| L8031 | BREAST PROSTHESIS, SILICONE OR EQUAL, WITH INTEGRAL ADHESIVE |
| L8032 | NIPPLE PROSTHESIS, REUSABLE, ANY TYPE, EACH |
| Q0138 | INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (NON-ESRD USE) |
| Q0139 | INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (FOR ESRD ON DIALYSIS) |
| Q0506 | BATTERY, LITHIUM- ION, FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY |
| Q4074 | ILOPROST, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 20 MICROGRAMS |
Discontinued Codes With Replacement Crosswalk HCPCS Codes
The following codes will be deleted effective for dates of service on or after January 1, 2010. There is no grace period for the deletions. If these codes are billed for dates of service on or after January 1, 2010, they will be returned as unprocessable or denied as an invalid code. Review descriptions of codes listed in replacement column carefully as these may be slightly different than discontinued HCPCS code.
| Discontinued HCPCS Code | Replacement Crosswalk HCPCS Code |
|---|---|
| A4365 | A4456 |
| Q2023 | J7185 |
| Q4080 | Q4074 |
Discontinued Codes Without Replacement Codes
The following codes will be deleted effective for dates of service on or after January 1, 2010. There is no grace period for the deletions. If these codes are billed for dates of service on or after January 1, 2010, they will be returned as unprocessable or denied as an invalid code.
| Discontinued HCPCS Code |
|---|
| A6200 |
| A6201 |
| A6202 |
| A6542 |
| A6543 |
| E2223 |
| E2393 |
| E2399 |
| J0460 |
| J0530 |
| J0540 |
| J0550 |
| J0835 |
| J1565 |
| J7322 |
| J9170 |
| L0210 |
| L1800 |
| L1815 |
| L1825 |
| L1901 |
| L2770 |
| L3651 |
| L3652 |
| L3700 |
| L3701 |
| L3909 |
| L3911 |
| L6639 |
| Q2024 |
Verbiage Changes for 2010
The following list contains HCPCS codes for which verbiage will be changed effective January 1, 2010.
| HCPCS Code | Description |
|---|---|
| A6549 | GRADIENT COMPRESSION STOCKING/SLEEVE, NOT OTHERWISE SPECIFIED |
| E0249 | PAD FOR WATER CIRCULATING HEAT UNIT, FOR REPLACEMENT ONLY |
| E0441 | STATIONARY OXYGEN CONTENTS, GASEOUS, 1 MONTH'S SUPPLY = 1 UNIT |
| E0442 | STATIONARY OXYGEN CONTENTS, LIQUID, 1 MONTH'S SUPPLY = 1 UNIT |
| E0443 | PORTABLE OXYGEN CONTENTS, GASEOUS, 1 MONTH'S SUPPLY = 1 UNIT |
| E0444 | PORTABLE OXYGEN CONTENTS, LIQUID, 1 MONTH'S SUPPLY = 1 UNIT |
| E0700 | SAFETY EQUIPMENT, DEVICE OR ACCESSORY, ANY TYPE |
| E1035 | MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, WITH INTEGRATED SEAT, OPERATED BY CARE GIVER, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 LBS |
| J0585 | INJECTION, ONABOTULINUMTOXINA, 1 UNIT |
| J0587 | INJECTION, RIMABOTULINUMTOXINB, 100 UNITS |
| J7192 | FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., NOT OTHERWISE SPECIFIED |
| L4396 | STATIC OR DYNAMIC ANKLE FOOT ORTHOSIS, INCLUDING SOFT INTERFACE MATERIAL, ADJUSTABLE FOR FIT, FOR POSITIONING, MAY BE USED FOR MINIMAL AMBULATION, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L8030 | BREAST PROSTHESIS, SILICONE OR EQUAL, WITHOUT INTEGRAL ADHESIVE |
| L8619 | COCHLEAR IMPLANT, EXTERNAL SPEECH PROCESSOR AND CONTROLLER, INTEGRATED SYSTEM, REPLACEMENT |
| L8680 | IMPLANTABLE NEUROSTIMULATOR ELECTRODE (WITH ANY NUMBER OF CONTACT POINTS), EACH |
| Q0496 | BATTERY, OTHER THAN LITHIUM- ION, FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY |
| Q2009 | INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT |
New Modifiers for 2010
The following new modifier is effective January 1, 2010.
| Modifier | Description |
|---|---|
| J4 | DMEPOS ITEM SUBJECT TO DMEPOS COMPETITIVE BIDDING PROGRAM THAT IS FURNISHED BY A HOSPITAL UPON DISCHARGE |
