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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/

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