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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
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