2021 HCPCS Code Update - October Edition - Correct Coding
Joint DME MAC and PDAC Publication
The following tables identify changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for October 2021. The tables contain only HCPCS codes applicable to items within Medicare DME MAC jurisdiction. There may be other HCPCS code changes for items under the jurisdiction of other Medicare contractors. Consult those contractors for information regarding HCPCS codes within their areas of responsibility.
All HCPCS code changes are effective for claims with dates of service on or after October 1, 2021.
Code Change Categories
- Added Codes/Modifiers: Identifies newly created codes and modifiers. Listing of a code in the tables does not necessarily indicate coverage (Emphasis added). Refer to the applicable Local Coverage Determination for information regarding Medicare reimbursement requirements.
- Discontinued Codes/Deleted Modifiers: Identifies codes and modifiers discontinued or deleted in the new cycle. These codes and modifiers continue to be valid for Medicare claims with dates of service either on or before September 30, 2021. There is no grace period for submission of a discontinued code/modifier for claims with dates of service after its effective end date. If there is a direct crosswalk for a discontinued/deleted code or modifier, the crosswalk code will be displayed in a table.
- Narrative Changes: Identifies changes in the narrative descriptor for an existing code or modifier. There were no narrative changes in this cycle.
Added Codes
Bowel Management Devices
| Code | Narrative |
| A4453 | RECTAL CATHETER FOR USE WITH THE MANUAL PUMP-OPERATED ENEMA SYSTEM, REPLACEMENT ONLY |
Miscellaneous
| Code | Narrative |
| K1021 | EXSUFFLATION BELT, INCLUDES ALL SUPPLIES AND ACCESSORIES |
| K1022 | ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL, KNEE DISARTICULATION, ABOVE KNEE, HIP DISARTICULATION, POSITIONAL ROTATION UNIT, ANY TYPE |
| K1023 | DISTAL TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR, STIMULATES PERIPHERAL NERVES OF THE UPPER ARM |
| K1024 | NON-PNEUMATIC COMPRESSION CONTROLLER WITH SEQUENTIAL CALIBRATED GRADIENT PRESSURE |
| K1025 | NON-PNEUMATIC SEQUENTIAL COMPRESSION GARMENT, FULL ARM |
| K1026 | MECHANICAL ALLERGEN PARTICLE BARRIER/INHALATION FILTER, CREAM, NASAL, TOPICAL |
| K1027 | ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, WITHOUT FIXED MECHANICAL HINGE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
Narrative Changes
| Code | Old Narrative | New Narrative |
| J1443 | INJECTION, FERRIC PYROPHOSPHATE CITRATE SOLUTION, 0.1 MG OF IRON | INJECTION, FERRIC PYROPHOSPHATE CITRATE SOLUTION (TRIFERIC), 0.1 MG OF IRON |
| J2407 | INJECTION, ORITAVANCIN, 10 MG | INJECTION, ORITAVANCIN (ORBACTIV), 10 MG |
| K1013 | ENEMA TUBE, ANY TYPE, REPLACEMENT ONLY, EACH | ENEMA TUBE, WITH OR WITHOUT ADAPTER, ANY TYPE, REPLACEMENT ONLY, EACH |
For questions about correct coding or products not listed on the DMECS Product Classification List (PCL), contact the Pricing, Data Analysis and Coding (PDAC) HCPCS Helpline at (877) 735-1326 during the hours of 9:30 am to 5:00 pm ET, Monday through Friday. You may also visit the PDAC website to chat with a representative, or select the Contact Us button at the top of the PDAC website for email, FAX, or postal mail information.
| Date | Update |
|---|---|
| 10/13/2021 | Published on PDAC website |