HCPCS Code Update – 2011
The following list identifies changes to level II Healthcare Common Procedure Coding System (HCPCS) codes for 2011. Please refer to Change Requests 7300, 7064 and 7121 published on the Centers for Medicare and Medicaid Services (CMS) website.
Added Codes/Added Modifiers: New codes and modifiers are effective for dates of service on or after January 1, 2011.
Discontinued Codes/Deleted Modifiers: Codes or modifiers that are discontinued/deleted will continue to be valid for claims with dates of service on or before December 31, 2010, regardless of the date of claim submission. If there is a direct crosswalk for a discontinued/deleted code or modifier, it is listed in the table. The crosswalked codes are also “added” codes effective for dates of service on or after January 1, 2011.
Narrative Changes/Revised Modifiers: A description change for an existing code or modifier is effective for dates of service on or after January 1, 2011.
The appearance of a code in this list does not necessarily indicate coverage.
Ankle-Foot/Knee-Ankle-Foot Orthoses
Added Code
| Code | Narrative |
| L4631 | ANKLE FOOT ORTHOSIS, WALKING BOOT TYPE, VARUS/VALGUS CORRECTION, ROCKER BOTTOM, ANTERIOR TIBIAL SHELL, SOFT INTERFACE, CUSTOM ARCH SUPPORT, PLASTIC OR OTHER MATERIAL, INCLUDES STRAPS AND CLOSURES, CUSTOM FABRICATED |
Enteral Nutrition
Narrative Changes
| Code | Old Narrative | New Narrative |
| B4034 | ENTERAL FEEDING SUPPLY KIT; SYRINGE FED, PER DAY | ENTERAL FEEDING SUPPLY KIT; SYRINGE FED, PER DAY, INCLUDES BUT NOT LIMITED TO FEEDING/FLUSHING SYRINGE, ADMINISTRATION SET TUBING, DRESSINGS, TAPE |
| B4035 | ENTERAL FEEDING SUPPLY KIT; PUMP FED, PER DAY |
ENTERAL FEEDING SUPPLY KIT; PUMP FED, PER DAY, INCLUDES BUT NOT LIMITED TO FEEDING/FLUSHING SYRINGE, ADMINISTRATION SET TUBING, DRESSINGS, TAPE |
| B4036 | ENTERAL FEEDING SUPPLY KIT; GRAVITY FED, PER DAY | ENTERAL FEEDING SUPPLY KIT; GRAVITY FED, PER DAY, INCLUDES BUT NOT LIMITED TO FEEDING/FLUSHING SYRINGE, ADMINISTRATION SET TUBING, DRESSINGS, TAPE |
External Infusion Pumps
Added Code
| Code | Narrative |
| J1559 | INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG |
Discontinued Code
| Code | Narrative | Crosswalk to Code |
| J9110 | INJECTION, CYTARABINE, 500 MG | J9100 |
| J9375 | VINCRISTINE SULFATE, 2 MG | J9370 |
| J9380 | VINCRISTINE SULFATE, 5 MG | J9370 |
Home Dialysis Supplies and Equipment
INVALID FOR SUBMISSION TO DME MAC
| Code | Narrative |
| A4651 | CALIBRATED MICROCAPILLARY TUBE, EACH |
| A4652 | MICROCAPILLARY TUBE SEALANT |
| A4653 | PERITONEAL DIALYSIS CATHETER ANCHORING DEVICE, BELT, EACH |
| A4671 | DISPOSABLE CYCLER SET USED WITH CYCLER DIALYSIS MACHINE, EACH |
| A4672 | DRAINAGE EXTENSION LINE, STERILE, FOR DIALYSIS, EACH |
| A4673 | EXTENSION LINE WITH EASY LOCK CONNECTORS, USED WITH DIALYSIS |
| A4674 | CHEMICALS/ANTISEPTICS SOLUTION USED TO CLEAN/STERILIZE DIALYSIS EQUIPMENT, PER 8 OZ |
| A4680 | ACTIVATED CARBON FILTER FOR HEMODIALYSIS, EACH |
| A4690 | DIALYZER (ARTIFICIAL KIDNEYS), ALL TYPES, ALL SIZES, FOR HEMODIALYSIS, EACH |
| A4706 | BICARBONATE CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER GALLON |
| A4707 | BICARBONATE CONCENTRATE, POWDER, FOR HEMODIALYSIS, PER PACKET |
| A4708 | ACETATE CONCENTRATE SOLUTION, FOR HEMODIALYSIS, PER GALLON |
| A4709 | ACID CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER GALLON |
| A4714 | TREATED WATER (DEIONIZED, DISTILLED, OR REVERSE OSMOSIS) FOR PERITONEAL DIALYSIS, PER GALLON |
| A4719 | "Y SET" TUBING FOR PERITONEAL DIALYSIS |
| A4720 | DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 249CC, BUT LESS THAN OR EQUAL TO 999CC, FOR PERITONEAL DIALYSIS |
| A4721 | DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 999CC BUT LESS THAN OR EQUAL TO 1999CC, FOR PERITONEAL DIALYSIS |
| A4722 | DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 1999CC BUT LESS THAN OR EQUAL TO 2999CC, FOR PERITONEAL DIALYSIS |
| A4723 | DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 2999CC BUT LESS THAN OR EQUAL TO 3999CC, FOR PERITONEAL DIALYSIS |
| A4724 | DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 3999CC BUT LESS THAN OR EQUAL TO 4999CC, FOR PERITONEAL DIALYSIS |
| A4725 | DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 4999CC BUT LESS THAN OR EQUAL TO 5999CC, FOR PERITONEAL DIALYSIS |
| A4726 | DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 5999CC, FOR PERITONEAL DIALYSIS |
| A4728 | DIALYSATE SOLUTION, NON-DEXTROSE CONTAINING, 500 ML |
| A4730 | FISTULA CANNULATION SET FOR HEMODIALYSIS, EACH |
| A4736 | TOPICAL ANESTHETIC, FOR DIALYSIS, PER GRAM |
| A4737 | INJECTABLE ANESTHETIC, FOR DIALYSIS, PER 10 ML |
| A4740 | SHUNT ACCESSORY, FOR HEMODIALYSIS, ANY TYPE, EACH |
| A4750 | BLOOD TUBING, ARTERIAL OR VENOUS, FOR HEMODIALYSIS, EACH |
| A4755 | BLOOD TUBING, ARTERIAL AND VENOUS COMBINED, FOR HEMODIALYSIS, EACH |
| A4760 | DIALYSATE SOLUTION TEST KIT, FOR PERITONEAL DIALYSIS, ANY TYPE, EACH |
| A4765 | DIALYSATE CONCENTRATE, POWDER, ADDITIVE FOR PERITONEAL DIALYSIS, PER PACKET |
| A4766 | DIALYSATE CONCENTRATE, SOLUTION, ADDITIVE FOR PERITONEAL DIALYSIS, PER 10 ML |
| A4770 | BLOOD COLLECTION TUBE, VACUUM, FOR DIALYSIS, PER 50 |
| A4771 | SERUM CLOTTING TIME TUBE, FOR DIALYSIS, PER 50 |
| A4772 | BLOOD GLUCOSE TEST STRIPS, FOR DIALYSIS, PER 50 |
| A4773 | OCCULT BLOOD TEST STRIPS, FOR DIALYSIS, PER 50 |
| A4774 | AMMONIA TEST STRIPS, FOR DIALYSIS, PER 50 |
| A4802 | PROTAMINE SULFATE, FOR HEMODIALYSIS, PER 50 MG |
| A4860 | DISPOSABLE CATHETER TIPS FOR PERITONEAL DIALYSIS, PER 10 |
| A4870 | PLUMBING AND/OR ELECTRICAL WORK FOR HOME HEMODIALYSIS EQUIPMENT |
| A4890 | CONTRACTS, REPAIR AND MAINTENANCE, FOR HEMODIALYSIS EQUIPMENT |
| A4911 | DRAIN BAG/BOTTLE, FOR DIALYSIS, EACH |
| A4913 | MISCELLANEOUS DIALYSIS SUPPLIES, NOT OTHERWISE SPECIFIED |
| A4918 | VENOUS PRESSURE CLAMP, FOR HEMODIALYSIS, EACH |
| A4928 | SURGICAL MASK, PER 20 |
| A4929 | TOURNIQUET FOR DIALYSIS, EACH |
| E1500 | CENTRIFUGE, FOR DIALYSIS |
| E1510 | KIDNEY, DIALYSATE DELIVERY SYST. KIDNEY MACHINE, PUMP RECIRCULATING, AIR REMOVAL SYST, FLOWRATE METER, POWER OFF, HEATER AND TEMPERATURE CONTROL WITH ALARM, I.V.POLES, PRESSURE GAUGE, CONCENTRATE CONTAINER |
| E1520 | HEPARIN INFUSION PUMP FOR HEMODIALYSIS |
| E1530 | AIR BUBBLE DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT |
| E1540 | PRESSURE ALARM FOR HEMODIALYSIS, EACH, REPLACEMENT |
| E1550 | BATH CONDUCTIVITY METER FOR HEMODIALYSIS, EACH |
| E1560 | BLOOD LEAK DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT |
| E1570 | ADJUSTABLE CHAIR, FOR ESRD PATIENTS |
| E1575 | TRANSDUCER PROTECTORS/FLUID BARRIERS, FOR HEMODIALYSIS, ANY SIZE, PER 10 |
| E1580 | UNIPUNCTURE CONTROL SYSTEM FOR HEMODIALYSIS |
| E1590 | HEMODIALYSIS MACHINE |
| E1592 | AUTOMATIC INTERMITTENT PERITIONEAL DIALYSIS SYSTEM |
| E1594 | CYCLER DIALYSIS MACHINE FOR PERITONEAL DIALYSIS |
| E1600 | DELIVERY AND/OR INSTALLATION CHARGES FOR HEMODIALYSIS EQUIPMENT |
| E1610 | REVERSE OSMOSIS WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS |
| E1615 | DEIONIZER WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS |
| E1620 | BLOOD PUMP FOR HEMODIALYSIS, REPLACEMENT |
| E1625 | WATER SOFTENING SYSTEM, FOR HEMODIALYSIS |
| E1630 | RECIPROCATING PERITONEAL DIALYSIS SYSTEM |
| E1632 | WEARABLE ARTIFICIAL KIDNEY, EACH |
| E1634 | PERITONEAL DIALYSIS CLAMPS, EACH |
| E1635 | COMPACT (PORTABLE) TRAVEL HEMODIALYZER SYSTEM |
| E1636 | SORBENT CARTRIDGES, FOR HEMODIALYSIS, PER 10 |
| E1637 | HEMOSTATS, EACH |
| E1699 | DIALYSIS EQUIPMENT, NOT OTHERWISE SPECIFIED |
Intravenous Immune Globulin
Added Code
| Code | Narrative |
| J1599 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOT OTHERWISE SPECIFIED, 500 MG |
Lower Limb Prostheses
Added Code
| Code | Narrative |
| L5961 | ADDITION, ENDOSKELETAL SYSTEM, POLYCENTRIC HIP JOINT, PNEUMATIC OR HYDRAULIC CONTROL, ROTATION CONTROL, WITH OR WITHOUT FLEXION AND/OR EXTENSION CONTROL |
Mechanical In-Exsufflation Devices
Added Code
| Code | Narrative |
| A7020 | INTERFACE FOR COUGH STIMULATING DEVICE, INCLUDES ALL COMPONENTS, REPLACEMENT ONLY |
Miscellaneous
Added Code
| Code | Narrative |
| A4566 | SHOULDER SLING OR VEST DESIGN, ABDUCTION RESTRAINER, WITH OR WITHOUT SWATHE CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (Note: Noncovered; No benefit category) |
| A9273 | HOT WATER BOTTLE, ICE CAP OR COLLAR, HEAT AND/OR COLD WRAP, ANY TYPE (Note: Noncovered; No benefit category) |
| E1831 | STATIC PROGRESSIVE STRETCH TOE DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES |
| L3674 | SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT BAR, WITH OR WITHOUT NONTORSION JOINT/TURNBUCKLE, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
Narrative Changes
| Code | Old Narrative | New Narrative |
| L3671 | SHOULDER ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
SHOULDER ORTHOSIS, SHOULDER JOINT DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3677 | SHOULDER ORTHOSIS, HARD PLASTIC, SHOULDER STABILIZER, PRE-FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
SHOULDER ORTHOSIS, SHOULDER JOINT DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
Discontinued Code
| Code | Narrative | Crosswalk to Code |
| E0220 | HOT WATER BOTTLE | A9273 |
| E0230 | ICE CAP OR COLLAR | A9273 |
| E0238 | NON-ELECTRIC HEAT PAD, MOIST | A9273 |
| L3672 | SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT BAR, WITHOUT JOINTS, MAY INLCUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT | L3674 |
| L3673 | SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT BAR, INCLUDES NONTORSION JOINT/TURNBUCKLE, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT | L3674 |
Nebulizers
Added Code
| Code | Narrative |
| J7686 | TREPROSTINIL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NONOMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 1.74 MG |
Narrative Changes
| Code | Old Narrative | New Narrative |
| A7013 | FILTER, DISPOSABLE, USED WITH AEROSOL COMPRESSOR | FILTER, DISPOSABLE, USED WITH AEROSOL COMPRESSOR OR ULTRASONIC GENERATOR |
Ostomy Supplies
Narrative Changes
| Code | Old Narrative | New Narrative |
| A4399 | OSTOMY IRRIGATION SUPPLY; CONE/CATHETER, INCLUDING BRUSH | OSTOMY IRRIGATION SUPPLY; CONE/CATHETER, WITH OR WITHOUT BRUSH |
Oxygen
Added Code
| Code | Narrative |
| E0446 | TOPICAL OXYGEN DELIVERY SYSTEM, NOT OTHERWISE SPECIFIED, INCLUDES ALL SUPPLIES AND ACCESSORIES (Note: Denied as not medically necessary; National Coverage Determination 20.29[C]) |
Surgical Dressings
Narrative Changes
| Code | Old Narrative | New Narrative |
| A6011 | COLLAGEN BASED WOUND FILLER, GEL/PASTE, STERILE, PER GRAM OF COLLAGEN | COLLAGEN BASED WOUND FILLER, GEL/PASTE, PER GRAM OF COLLAGEN |
| A6248 | HYDROGEL DRESSING, WOUND FILLER, GEL, STERILE, PER FLUID OUNCE | HYDROGEL DRESSING, WOUND FILLER, GEL, PER FLUID OUNCE |
| A6260 | WOUND CLEANSERS, STERILE, ANY TYPE, ANY SIZE | WOUND CLEANSERS, ANY TYPE, ANY SIZE |
| A6261 | WOUND FILLER, GEL/PASTE, STERILE, PER FLUID OUNCE, NOT OTHERWISE SPECIFIED | WOUND FILLER, GEL/PASTE, PER FLUID OUNCE, NOT OTHERWISE SPECIFIED |
| A6262 | WOUND FILLER, DRY FORM, STERILE, PER GRAM, NOT OTHERWISE SPECIFIED | WOUND FILLER, DRY FORM, PER GRAM, NOT OTHERWISE SPECIFIED |
Urological Supplies
Narrative Changes
| Code | Old Narrative | New Narrative |
| A5112 | URINARY LEG BAG; LATEX | URINARY DRAINAGE BAG, LEG OR ABDOMEN, LATEX, WITH OR WITHOUT TUBE, WITH STRAPS, EACH |
Wheelchair Seating
Added Code
| Code | Narrative |
| E2622 | SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH LESS THAN 22 INCHES, ANY DEPTH |
| E2623 | SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH 22 INCHES OR GREATER, ANY DEPTH |
| E2624 | SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH LESS THAN 22 INCHES, ANY DEPTH |
| E2625 | SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH 22 INCHES OR GREATER, ANY DEPTH |
Discontinued Code
| Code | Narrative | Crosswalk to Code |
| K0734 | SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH LESS THAN 22 INCHES, ANY DEPTH | E2622 |
| K0735 | SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH 22 INCHES OR GREATER, ANY DEPTH | E2623 |
| K0736 | SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH LESS THAN 22 INCHES, ANY DEPTH | E2624 |
| K0737 | SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH 22 INCHES OR GREATER, ANY DEPTH | E2625 |
Modifiers
Added Code
| Code | Narrative |
| AY | ITEM OR SERVICE FURNISHED TO AN ESRD PATIENT THAT IS NOT FOR THE TREATMENT OF ESRD |
| CS |
ITEM OR SERVICE RELATED, IN WHOLE OR IN PART, TO AN ILLNESS, INJURY, OR CONDITION THAT WAS CAUSED BY OR EXACERBATED BY THE EFFECTS, DIRECT OR INDIRECT, OF THE 2010 OIL SPILL IN THE GULF OF MEXICO, INCLUDING BUT NOT LIMITED TO SUBSEQUENT CLEAN-UP ACTIVITIES NOTE: This modifier was effective as of April 20, 2010. |
| GU | WAIVER OF LIABILITY STATEMENT ISSUED AS REQUIRED BY PAYER POLICY, ROUTINE NOTICE |
| NB | NEBULIZER SYSTEM, ANY TYPE, FDA-CLEARED FOR USE WITH SPECIFIC DRUG |
Narrative Changes
| Code | Old Narrative | New Narrative |
| GA | WAIVER OF LIABILITY STATEMENT ON FILE | WAIVER OF LIABILITY STATEMENT ISSUED AS REQUIRED BY PAYER POLICY, INDIVIDUAL CASE |
| Date | Update |
|---|---|
| 12/17/2010 | Published on PDAC website |
Last Updated: 12/17/2010