CMS: Quarterly Update to HCPCS Level II Codes

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In CMS
January 14, 2011
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The Centers for Medicare & Medicaid Services (CMS) released modifications to the Healthcare Common Procedure Coding System Level II (HCPCS Level II ) code set. The quarterly update includes in the Procedures/Professional Services section two new codes for drug screening and tobacco cessation and two revised codes for drug screening and rapid antibody testing for infectious antigens. In a separate quarterly update, CMS has discontinued four temporary codes and added one.

Effective April 1, 2011, CMS is adding coverage for temporary HCPCS Level II code Q2040 Injection, incobotulinumtoxin A, 1 unit.

Discontinued effective March 31, 2011 are four temporary codes, shown in the table below.

HCPCS Description
Q1003 New technology, intraocular lens, category 3 (reduced spherical aberration)
S2270 Insertion of vaginal cylinder for application of radiation source or clinical brachytherapy (report separately in addition to radiation source delivery)
S2344 Nasal/sinus endoscopy, surgical; with enlargement of sinus ostium opening using inflatable device (ie, balloon sinoplasty)
S3905 Noninvasive electrodiagnostic testing with automatic computerized hand-held device to stimulate and measure neuromuscular signals in diagnosing and evaluating systemic and entrapment neuropathies

The update to G codes is shown in the table below. Changes for these codes are effective Jan. 1, 2011.

HCPCS Status Long description
G0151 active Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes
G0152 active Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes
G0153 active Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
G0154 active Direct skilled nursing services of a licensed nurse (LPN or RN) in the home health or hospice setting, each 15 minutes
G0157 active Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes
G0158 active Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes
G0159 active Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes
G0160 active Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
G0161 active Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language therapy maintenance program, each 15 minutes
G0162 active Skilled services by a registered nurse (RN) for management and evaluation of the plan of care; each 15 minutes (The patient’s underlying condition or complication requires an RN to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)
G0163 active Skilled services of a licensed nurse (LPN or RN) for the observation and assessment of the patient’s condition, each 15 minutes (The change in the patient’s condition requires skilled nursing personnel to identify and evaluate the patient’s need for possible modification of treatment in the home health or hospice setting)
G0164 active Skilled services of a licensed nurse (LPN or RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes
G0431 revised Drug Screen single class, high complexity test, (e.g. immunoassay, enzyme assay), each specimen
G0434 new Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter
G0435 revised Infectious agent antigen detection by rapid antibody test of oral mucosa transudate, HIV-1 or HIV-2, screening
G0436 new Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes

2 Responses to “CMS: Quarterly Update to HCPCS Level II Codes”

  1. robin fernandez says:

    What about the new J codes effective 1/1/2011. There were three J codes I had to find out the hard way that they had been changed. I have seen no releases anywhere on these codes. How are we supposed to learn of these HCPCS code updates?

  2. Gil says:

    You can go to the CMS Website Page for this information for Updates. The updates are every Jan., April, July and October. Go to http://www.cms.gov/HCPCSReleaseCodeSets/ Then click on “HCPCS Quarterly Update”, then click on “Other Codes”. If, there are any new J code updates, they would be in there. You can then click on “G-codes” or “C-codes” when you need to review for these updates. I hope this helps you.

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