Correct Coding - 2017 HCPCS Code Annual Update
DME MAC Joint Publication
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
Narrative Changes
| Code | New Narrative | Old Narrative |
| E0967 | MANUAL WHEELCHAIR ACCESSORY, HAND RIM WITH PROJECTIONS, ANY TYPE, REPLACEMENT ONLY, EACH | MANUAL WHEELCHAIR ACCESSORY, HAND RIM WITH PROJECTIONS, ANY TYPE, EACH |
| E0995 | WHEELCHAIR ACCESSORY, CALF REST/PAD, REPLACEMENT ONLY, EACH | WHEELCHAIR ACCESSORY, CALF REST/PAD, EACH |
| E2206 | MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK ASSEMBLY, COMPLETE, REPLACEMENT ONLY, EACH | MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK ASSEMBLY, COMPLETE, EACH |
| E2220 | MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) PROPULSION TIRE, ANY SIZE, REPLACEMENT ONLY, EACH | MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) PROPULSION TIRE, ANY SIZE, EACH |
| E2221 | MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE), ANY SIZE, REPLACEMENT ONLY, EACH | MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE), ANY SIZE, EACH |
| E2222 | MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE WITH INTEGRATED WHEEL, ANY SIZE, REPLACEMENT ONLY, EACH | MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE WITH INTEGRATED WHEEL, ANY SIZE, EACH |
| E2224 | MANUAL WHEELCHAIR ACCESSORY, PROPULSION WHEEL EXCLUDES TIRE, ANY SIZE, REPLACEMENT ONLY, EACH | MANUAL WHEELCHAIR ACCESSORY, PROPULSION WHEEL EXCLUDES TIRE, ANY SIZE, EACH |
| K0015 | DETACHABLE, NON-ADJUSTABLE HEIGHT ARMREST, REPLACEMENT ONLY, EACH | DETACHABLE, NON-ADJUSTABLE HEIGHT ARMREST, EACH |
| K0019 | ARM PAD, REPLACEMENT ONLY, EACH | ARM PAD, EACH |
| K0037 | HIGH MOUNT FLIP-UP FOOTREST, REPLACEMENT ONLY, EACH | HIGH MOUNT FLIP-UP FOOTREST, EACH |
| K0042 | STANDARD SIZE FOOTPLATE, REPLACEMENT ONLY, EACH | STANDARD SIZE FOOTPLATE, EACH |
| K0043 | FOOTREST, LOWER EXTENSION TUBE, REPLACEMENT ONLY, EACH | FOOTREST, LOWER EXTENSION TUBE, EACH |
| K0044 | FOOTREST, UPPER HANGER BRACKET, REPLACEMENT ONLY, EACH | FOOTREST, UPPER HANGER BRACKET, EACH |
| K0045 | FOOTREST, COMPLETE ASSEMBLY, REPLACEMENT ONLY, EACH | FOOTREST, COMPLETE ASSEMBLY |
| K0046 | ELEVATING LEGREST, LOWER EXTENSION TUBE, REPLACEMENT ONLY, EACH | ELEVATING LEGREST, LOWER EXTENSION TUBE, EACH |
| K0047 | ELEVATING LEGREST, UPPER HANGER BRACKET, REPLACEMENT ONLY, EACH | ELEVATING LEGREST, UPPER HANGER BRACKET, EACH |
| K0050 | RATCHET ASSEMBLY, REPLACEMENT ONLY | RATCHET ASSEMBLY |
| K0051 | CAM RELEASE ASSEMBLY, FOOTREST OR LEGREST, REPLACEMENT ONLY, EACH | CAM RELEASE ASSEMBLY, FOOTREST OR LEGREST, EACH |
| K0052 | SWINGAWAY, DETACHABLE FOOTRESTS, REPLACEMENT ONLY, EACH | SWINGAWAY, DETACHABLE FOOTRESTS, EACH |
| K0069 | REAR WHEEL ASSEMBLY, COMPLETE, WITH SOLID TIRE, SPOKES OR MOLDED, REPLACEMENT ONLY, EACH | REAR WHEEL ASSEMBLY, COMPLETE, WITH SOLID TIRE, SPOKES OR MOLDED, EACH |
| K0070 | REAR WHEEL ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, SPOKES OR MOLDED, REPLACEMENT ONLY, EACH | REAR WHEEL ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, SPOKES OR MOLDED, EACH |
| K0071 | FRONT CASTER ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, REPLACEMENT ONLY, EACH | FRONT CASTER ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, EACH |
| K0072 | FRONT CASTER ASSEMBLY, COMPLETE, WITH SEMI-PNEUMATIC TIRE, REPLACEMENT ONLY, EACH | FRONT CASTER ASSEMBLY, COMPLETE, WITH SEMI-PNEUMATIC TIRE, EACH |
| K0077 | FRONT CASTER ASSEMBLY, COMPLETE, WITH SOLID TIRE, REPLACEMENT ONLY, EACH | FRONT CASTER ASSEMBLY, COMPLETE, WITH SOLID TIRE, EACH |
| K0098 | DRIVE BELT FOR POWER WHEELCHAIR, REPLACEMENT ONLY | DRIVE BELT FOR POWER WHEELCHAIR |
| Date | Update |
|---|---|
| 12/01/2016 | Published on PDAC website |