Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 3940 Date: December 22, 2017 Change Request 10385

Department of Health & CMS Manual System Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 3940 Date: December 22, 2017 Change Request 10385

SUBJECT: January 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.0

I. SUMMARY OF CHANGES: This notification provides the Integrated OCE instructions and specifications for the Integrated OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The attached Recurring Update Notification applies to 100-04, Chapter 4, section 40.1.

EFFECTIVE DATE: January 1, 2018 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: January 2, 2018

Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.

II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row.

R/N/D CHAPTER / SECTION / SUBSECTION / TITLE N/A N/A

III. FUNDING: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

IV. ATTACHMENTS:

Recurring Update Notification

Attachment - Recurring Update Notification

Pub. 100-04 Transmittal: 3940 Date: December 22, 2017 Change Request: 10385

SUBJECT: January 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.0

EFFECTIVE DATE: January 1, 2018 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: January 2, 2018

I. GENERAL INFORMATION

A. Background: This instruction informs the A/B MACs Part A, the A/B MACs Part HHH and the Fiscal Intermediary Shared System (FISS) that the I/OCE is being updated for January 1, 2018. The I/OCE routes all institutional outpatient claims (which includes non-OPPS hospital claims) through a single integrated OCE. The attached Recurring Update Notification applies to 100-04, Chapter 4, section 40.1.

B. Policy: This notification provides the Integrated OCE instructions and specifications for the Integrated OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The I/OCE specifications will be posted to the CMS Website and can be found at http://www.cms.gov/OutpatientCodeEdit/.

II. BUSINESS REQUIREMENTS TABLE

"Shall" denotes a mandatory requirement, and "should" denotes an optional requirement.

Number Requirement Responsibility A/B D Shared- Other MAC M System E Maintainers A B H F M V C H M I C M W H A S S S F C S 10385.1 The Shared System Maintainer shall install the X Integrated OCE (I/OCE) into their systems.

10385.2 Medicare contractors shall identify the I/OCE X X X specifications on the CMS Website at http://www.cms.gov/OutpatientCodeEdit/.

III. PROVIDER EDUCATION TABLE

Number Requirement Responsibility

A/B D C MAC M E E D A B H I H M H A C 10385.3 MLN Article: A provider education article related to this instruction will be X X available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning- Network-MLN/MLNMattersArticles/ shortly after the CR is released. You will receive notification of the article release via the established "MLN Matters" listserv. Contractors shall post this article, or a direct link to this article, on their Web sites and include information about it in a listserv message within 5 business days after receipt of the notification from CMS announcing the availability of the article. In addition, the provider education article shall be included in the contractor's next regularly scheduled bulletin. Contractors are free to supplement MLN Matters articles with localized information that would benefit their provider community in billing and administering the Medicare program correctly.

IV. SUPPORTING INFORMATION

Section A: Recommendations and supporting information associated with listed requirements: N/A

"Should" denotes a recommendation.

X-Ref Recommendations or other supporting information: Requirement Number

Section B: All other recommendations and supporting information: N/A

V. CONTACTS

Pre-Implementation Contact(s): Yvonne Young, [email protected] , Marina Kushnirova, [email protected] , Fred Rooke, [email protected]

Post-Implementation Contact(s): Contact your Contracting Officer's Representative (COR).

VI. FUNDING

Section A: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

ATTACHMENTS: 1

Summary81 of Quarterly Release Modifications

The modifications of the IOCE for the January 2018 V19.0 release are summarized in the table below. Readers should also read through the entire document and note the highlighted sections, which also indicate changes from the prior release of the software. Some IOCE modifications in the update may be retroactively added to prior releases. If so, the retroactive date appears in the 'Effective Date' column.

# Type Effective Edits Modification Date Affected 1 Logic 1/1/2018 24 Modify the software to maintain 28 prior quarters (7 years) of programs in each release. Remove older versions with each release. The earliest date included for this release is 4/1/2011. 2 Interface 1/1/2018 Updates to the following tables (additional details included in the tables): Table 1: IOCE Control Block - Add Value Codes and Value Code Amounts, up to 36 - Increase the number of Condition Codes to 30 - Increase the number of Occurrence Codes to 30 - Remove the following fields: Ndxptr, Nsgptr, NCCptr, NOccptr, CodeTypePtr - Modify the Comments for the following fields: Dxeditptr, Proceditptr, Mdeditptr, Dteditptr, Rceditptr, APCptr, Claimptr Table 5: Claim Return Buffer - Add Payer Condition Code field Table 7: APC Return Buffer - Add HCPCS Modifier field 3 Logic 1/1/2016 Update program logic for drug HCPCS lines with SI of G or K to return the Payment APC (see processing logic and Appendix E). 4 Logic 1/1/2018 Update Appendix K to note the deletion of composite APC 8001. 5 Logic 1/1/2018 Implement program logic for payment reduction of x-rays taken using computed radiography technology. HCPCS codes reporting modifier FY are assigned new payment adjustment flag value 22 (CAA Section 502(b) reduction on computed radiography technology) (see special processing logic and Appendix G). Note: Currently the list of HCPCS codes affected by this logic is the same as that used with modifier FX. 6 Logic 1/1/2018 Implement program logic for OPPS claims to assign a HCPCS level modifier to the line level output when drug HCPCS with SI = K are reported with new modifier JG. The IOCE adds modifier V3 to the line in the new ‘HCPCS modifier’ field of the program output (see processing logic and Table 7). 7 Logic 1/1/2017 102 Implement new edit 102: Modifiers PO/PN not allowed on the same line (RTP). Edit criteria: A claim line has both modifiers PO and PN present (see processing logic, Tables 4 and 5, and Appendix F(a) – Edits by Bill Type). 8 Logic 7/24/2017 103 Implement new edit 103: Modifier reported prior to FDA approval date (LID). Edit criteria: A modifier is reported prior to the mid-quarter activation date (see processing logic, Tables 4 and 5, and Appendix F(a) – Edits by Bill Type). 9 Logic 1/1/2017 Modify program logic for conditional packaging of laboratory services. Laboratory services with SI = Q4 have the SI changed to A if present with an OPPS procedure that has final SI = Q1 with a line item action flag of 2 or 3 applied (see processing logic). 10 Logic 6/5/2017 68 Implement mid-quarter NCD approval edit for procedure code 0421T. 11 Logic 1/1/2018 Update program logic for FQHC claims for new Chronic Care Management codes G0511, G0512. If either code is reported, assign Payment Indicator = 2 and bypass edits 88 and 89 if no FQHC payment code and/or qualifying visit code is reported (see Appendix M). 12 Logic 4/1/2011 Update program logic for services that may be subject to deductible or deductible/coinsurance waiver. If the services are packaged with SI = N and the line item charges = 0.00, do not assign payment adjustment flags 4, 9 or 10 (see processing logic where payment adjustment flags 4, 9 or 10 are applicable and Appendix G). 13 Logic 1/1/2018 22 Add the following new modifiers to the valid modifier list: - FY: Computed radiography x-ray - JG: 340B Acquired Drug - TB: Tracking 340B acquired drug - X1: Continuous/broad services - X2: Continuous/focused services - X3: Episodic/broad services - X4: Episodic/focused services - X5: Svc req by another clinician - 96: Habilitative services - 97: Rehabilitative services 14 Documentation 1/1/2018 Update Appendix D to reference HCPCS codes that have SI values different from its APC SI value and impact to discounting (see Appendix D). 15 Logic 10/1/2017 Update program logic for PHP claims to return Payer-defined Condition Codes in the following instances: - Return condition code MP if the PHP claim represents the initial admit week claim - Return condition code MQ if the PHP claim represents the final discharge week claim Note: edit 95 is not returned on an initial admit week or a final discharge week of a PHP claim (see processing logic). 16 Logic 1/1/2018 Update program logic for critical care ancillary services to discontinue the modifier 59 logic exception for code 36600; code no longer identified as critical care ancillary service (see processing logic). 17 Documentation 1/1/2018 Add new payment adjustment flag value 22 (see Appendix G). 18 Content 1/1/2018 Update the following lists for the release (see quarterly data files): # Type Effective Edits Modification Date Affected - Comprehensive APC ranking - Complexity-adjusted comprehensive APC code pairs - Critical Care ancillary services (conditional packaging) - Procedure and sex conflict (edit 8) - Bilateral procedure editing - Blood clotting factor and biologic response HCPCS (edit 99 exclusions) - Blood products (edit 73, code updates) - Skin substitute lists (edit 87 – code updates, see Appendix O) - Deductible/Coinsurance N/A list (code updates, Appendix O, Preventive Services) - Device Offset Code Pairs (code pair updates for pass-through device offset logic) - Device-Procedure; terminated device-procedures for offset (edit 92, code updates) - Pass-through drugs and biological APC offset amounts - Pass-through skin substitute products (code updates) - Radiation HCPCS for Section 603 (code updates) - CT Scan HCPCS subject to NEMA (code updates) - X-ray list for modifiers FX/FY (code updates) - Non-covered services lists (SI = E1, for edits 9, 28, 50, code updates) - Separate payment not provided list (SI = E2, edit 13) - Non-reportable for OPPS list (SI = B, edit 62) - Services not billable to MAC list (SI = M, edit 72) - FQHC non-covered list (code updates for FQHC and RHC claims) - FQHC flu vaccine list (code updates for FQHC claims) - FQHC Chronic Care Management (new codes for new list) 19 Content 1/1/2018 Make all HCPCS/APC/SI changes as specified by CMS (quarterly data files). 20 Content 1/1/2018 20, 40 Implement version 24.0 of the NCCI (as modified for applicable outpatient institutional providers). 21 Other 1/1/2018 Create 508-compliant versions of the Specifications, Summary of Data Changes and File Layout documents for publication on the CMS web site. Provide MF and PC IOCE software and supporting quarterly data file reports for publication on the CMS web site. 22 Other 1/1/2018 Deliver quarterly software update and all related documentation and files to users via electronic download.

FINAL

Summary of Data Changes

Integrated OCE v19.0

Effective January 1, 2018

Table of Contents

CPT codes, descriptions, and material only are Copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

DEFINITIONS ...... 3 APC CHANGES ...... 4 Added APCs ...... 4 Deleted APCs ...... 4 APC Description Changes ...... 5 APC Status Indicator Changes ...... 6 HCPCS/CPT PROCEDURE CODE CHANGES ...... 6 Added HCPCS/CPT Procedure Codes ...... 6 Deleted HCPCS/CPT Procedure Codes ...... 12 HCPCS Description Changes ...... 15 HCPCS Changes- APC, Status Indicator and/or Edit Assignments ...... 18 HCPCS Edit Changes ...... 28 Comprehensive APC Complexity Adjusted Code Pair Changes ...... 29 HCPCS Approval and/or Termination Date Changes...... 35 Edit Assignments ...... 35 Device Dependent Procedure Changes ...... 36 Device Credit Procedure Changes ...... 38 Pass Through Drug or Biological Offset Procedure Changes ...... 40 Deductible/Coinsurance Procedure Code Changes ...... 40 Skin Substitute Low Cost Product Procedure Changes ...... 40 Non-standard CT Scan Equipment Procedure Changes ...... 41 Section 603 HCPCS Exclusions ...... 41 FQHC PPS Procedure Changes ...... 41 Radiology Procedures Changes for Payment Adjustment ...... Error! Bookmark not defined. MODIFIERS ...... 42 Added Modifiers ...... 42 Deleted Modifiers ...... 42

DEFINITIONS

• A blank in a field indicates ‘no change’

• The “old” column describes the attribute prior to the change being made in the current update, which is indicated in the “new” column. If the effective date of the change is the same as the effective date of the new update, ‘old’ describes the attribute up to the last day of the previous quarter. If the effective date is retroactive, then ‘old’ describes the attribute for the same date in the previous release of the software.

• “Unassigned”, “Pre-defined” or “Placeholder” in APC or HCPCS descriptions indicates that the APC or HCPCS code is inactive. When the APC or HCPCS code is activated, it becomes valid for use in the OCE, and a new description appears in the “new description” column, with the appropriate effective date.

• Activation Date (ActivDate) indicates the mid-quarter date of FDA approval for a drug, or the mid- quarter date of a new or changed code resulting from a National Coverage Determination (NCD). The Activation Date is the date the code becomes valid for use in the OCE. If the Activation Date is blank, then the effective date takes precedence.

• Termination Date (TermDate) indicates the mid-quarter date when a code or change becomes inactive. A code is not valid for use in the OCE after its termination date.

• For codes with SI of “Q1, Q2, and Q3”, the APC assignment is the standard APC to which the code would be assigned if it is paid separately.

3 APC CHANGES

Added APCs

The following APC(s) were added to the IOCE, effective 01-01-18 APC APCDesc StatusIndicator 01907 New Technology - Level 52 ($145,001-$160,000) S 01908 New Technology - Level 52 ($145,001-$160,000) T 02644 Brachytx cesium-131 chloride U 04015 Radiation tx delivery imrt S 04016 Delivery comp imrt S 05184 Level 4 Vascular Procedures T 09014 Injection, cerliponase alfa G 09015 C-1 esterase, haegarda G 09016 Inj, triptorelin ext rel G 09028 Inj. inotuzumab ozogamicin G 09029 Injection, guselkumab G 09031 Inj, etelcalcetide, 0.1 mg K 09034 Inj cuvitru, 100 mg K 09064 Aripiprazole injection K 09065 Argatroban esrd dialysis 1mg K 09066 Inj dihydroergotamine mesylt K 09071 Capsaicin 8% patch K 09072 Fosphenytoin inj pe K 09075 Inj, kovaltry, 1 i.u. K 09076 Dimecaprol injection K 09077 Epoetin beta non esrd K 09078 Testosterone undecanoate 1mg K 09079 Genvisc 850, inj, 1mg K 09080 Fludarabine phosphate inj K 09081 Tisagenlecleucel car-pos t K 09301 Aminolevulinic acid, 10% gel G 09302 Inj, daunorubicin-cytarabine G 09495 Gemtuzumab ozogamicin inj G

Deleted APCs

The following APC(s) were deleted from the IOCE, effective 01-01-18 APC APCDesc 00747 Chlorothiazide sodium inj 00821 Daunorubicin citrate inj 00827 Floxuridine injection 00831 Ifosfamide injection 00913 Ganciclovir long act implant 01086 Temozolomide

4 APC APCDesc 01331 Olanzapine long-acting inj 01332 Antithrombin recombinant 01338 Methyl aminolevulinate, top 01361 Enfuvirtide injection 01424 Nabilone oral 01457 Totazoline hcl injection 01460 Interferon alfa-2a inj 01464 Factor VIII (porcine) 01605 Abciximab injection 01612 Daclizumab, parenteral 01633 Alefacept 01657 Puraply or puraply am 01661 Gen, neuro, HF, rechg bat 01663 Inj, phenylephrine ketorolac 01664 Florbetapir f18 01666 Tetracyclin injection 01676 P32 chromic phosphate 01693 Lepirudin 01738 Oxaliplatin 01741 Urofollitropin, 75 iu 01836 Penicillin g procaine inj 01838 Urokinase 250,000 iu inj 01839 Oral busulfan 01842 Leuprolide acetate implant 01855 Pralidoxime chloride inj 02613 Lung bx plug w/del sys 02623 Cath, translumin, drug-coat 03041 Bivalirudin 08001 LDR Prostate Brachytherapy Composite 09060 Diazoxide injection 09061 Inj milrinone lactate / 5 mg 09062 Topotecan injection 09248 Inj, clevidipine butyrate 09457 Inj sulf hexa lipid microsph

APC Description Changes

The following APC(s) had description changes, effective 01-01-18 APC Old Description New Description 00873 Hyalgan/supartz inj per dose Hyalgan supartz visco-3 dose 01862 Gel-syn injection 0.1 mg Gelsyn-3 injection 0.1 mg 01901 New Technology - Level 49 ($100,001-$120,000) New Technology - Level 49 ($100,001-$115,000) 01902 New Technology - Level 49 ($100,001-$120,000) New Technology - Level 49 ($100,001-$115,000) 01903 New Technology - Level 50 ($120,001-$140,000) New Technology - Level 50 ($115,001-$130,000) 01904 New Technology - Level 50 ($120,001-$140,000) New Technology - Level 50 ($115,001-$130,000) 01905 New Technology - Level 51 ($140,001-$160,000) New Technology - Level 51 ($130,001-$145,000) 01906 New Technology - Level 51 ($140,001-$160,000) New Technology - Level 51 ($130,001-$145,000) 09043 Afstyla Factor VIII recomb Inj, afstyla, 1 i.u. 09074 Inj, Makena Makena, 10 mg

5 APC Old Description New Description 09294 Inj, Taliglucerace Alfa 10 u Inj, taliglucerase alfa 10 u 09483 Injection, atezolizumab Inj, atezolizumab,10 mg 09484 Injection, eteplirsen Inj, eteplirsen, 10 mg 09485 Injection, olaratumab Inj, olaratumab, 10 mg 09486 Inj, granisetron ext Inj, granisetron, xr, 0.1 mg 09487 Ustekinumab IV Inj, 1 mg Ustekinumab, iv inject,1 mg 09488 Conivaptan HCL Conivaptan hcl 09489 Injection, nusinersen Inj, nusinersen, 0.1mg 09490 Injection, bezlotoxumab Inj, bezlotoxumab, 10 mg 09491 Injection, avelumab Injection, avelumab, 10 mg 09536 Platelets pheresis path reduc Platelets, pathogen reduced

APC Status Indicator Changes

The following APC(s) had Status Indicator changes, effective 01-01-18 APC Old SI New SI 01490 G K 01658 G K 01660 G K 01662 G K 01823 G K 09445 G K 09448 G K 09449 G K 09450 G K 09451 G K 09452 G K 09453 G K 09454 G K 09455 G K 09456 G K

HCPCS/CPT PROCEDURE CODE CHANGES

Added HCPCS/CPT Procedure Codes

The following new HCPCS/CPT code(s) were added to the IOCE, effective 10-01-17 HCPCS CodeDesc SI APC Edit ActivDate TermDate 0018U Onc thyr 10 microrna seq alg A 00000 0019U Onc rna tiss predict alg A 00000 0020U Rx test prsmv ur w/def conf Q4 00000 0021U Onc prst8 detcj 8 autoantb Q4 00000 0022U Trgt gen seq dna&rna 23 gene A 00000 0023U Onc aml dna detcj/nondetcj A 00000

The following new HCPCS/CPT code(s) were added to the IOCE, effective 01-01-18 HCPCS CodeDesc SI APC Edit ActivDate TermDate 00731 Anes upr gi ndsc px nos N 00000 00732 Anes upr gi ndsc px ercp N 00000 00811 Anes lwr intst ndsc nos N 00000 00812 Anes lwr intst scr colsc N 00000 00813 Anes upr lwr gi ndsc px N 00000 0479T Fxjl abl lsr 1st 100 sq cm T 05052 0480T Fxjl abl lsr ea addl 100sqcm N 00000 0481T Njx autol wbc concentrate Q1 05735 0482T Absl quan myocrd bld flo pet N 00000 0483T Tmvi percutaneous approach C 00000 0484T Tmvi transthoracic exposure C 00000 0485T Oct mid ear i&r unilateral Q1 05732 0486T Oct mid ear i&r bilateral Q1 05732 0487T Trvg biomchn mapg w/reprt Q1 05734 0488T Diabetes prev online/elec E1 00000 9 0489T Regn cell tx scldr hands E1 00000 9 0490T Regn cell tx scldr h mlt inj E1 00000 9 0491T Abl lsr opn wnd 1st 20 sqcm T 05052 0492T Abl lsr opn wnd addl 20 sqcm N 00000 0493T Near ifr spectrsc of wounds N 00000 0494T Prep & cannulj cdvr don lung C 00000 0495T Mntr cdvr don lng 1st 2 hrs C 00000 0496T Mntr cdvr don lng ea addl hr C 00000 0497T Xtrnl pt act ecg in-off conn Q1 05741 0498T Xtrnl pt act ecg r&i pr 30 d M 00000 72 0499T Cysto f/urtl strix/stenosis E1 00000 9 0500T Hpv 5+ hi risk hpv types A 00000 0501T Cor ffr derived cor cta data M 00000 72 0502T Cor ffr data prep & transmis N 00000 0503T Cor ffr alys gnrj ffr mdl S 01516 0504T Cor ffr data review i&r M 00000 72 15730 Mdfc flap w/prsrv vasc pedcl T 05055 15733 Musc myoq/fscq flp h&n pedcl T 05055 19294 Prep tum cav iort prtl mast N 00000 20939 Bone marrow aspir bone grfg N 00000 31241 Nsl/sins ndsc w/artery lig C 00000 31253 Nsl/sins ndsc total J1 05155 31257 Nsl/sins ndsc tot w/sphendt J1 05155 31259 Nsl/sins ndsc sphn tiss rmvl J1 05155 31298 Nsl/sins ndsc w/sins dilat J1 05155 32994 Ablate pulm tumor perq crybl J1 05361 33927 Impltj tot rplcmt hrt sys C 00000 33928 Rmvl & rplcmt tot hrt sys C 00000 33929 Rmvl rplcmt hrt sys f/trnspl C 00000 34701 Evasc rpr a-ao ndgft C 00000 34702 Evasc rpr a-ao ndgft rpt C 00000 34703 Evasc rpr a-unilac ndgft C 00000 34704 Evasc rpr a-unilac ndgft rpt C 00000 34705 Evac rpr a-biiliac ndgft C 00000

7 HCPCS CodeDesc SI APC Edit ActivDate TermDate 34706 Evasc rpr a-biiliac rpt C 00000 34707 Evasc rpr ilio-iliac ndgft C 00000 34708 Evasc rpr ilio-iliac rpt C 00000 34709 Plmt xtn prosth evasc rpr C 00000 34710 Dlyd plmt xtn prosth 1st vsl C 00000 34711 Dlyd plmt xtn prosth ea addl C 00000 34712 Tcat dlvr enhncd fixj dev C 00000 34713 Perq access & clsr fem art N 00000 34714 Opn fem art expos cndt crtj N 00000 34715 Opn ax/subcla art expos N 00000 34716 Opn ax/subcla art expos cndt N 00000 36465 Njx noncmpnd sclrsnt 1 vein T 05054 36466 Njx noncmpnd sclrsnt mlt vn T 05054 36482 Endoven ther chem adhes 1st T 05184 36483 Endoven ther chem adhes sbsq N 00000 38222 Dx bone marrow bx & aspir J1 05072 38573 Laps pelvic lymphadec J1 05362 43286 Esphg tot w/laps moblj C 00000 43287 Esphg dstl 2/3 w/laps moblj C 00000 43288 Esphg thrsc moblj C 00000 55874 Tprnl plmt biodegrdabl matrl T 05375 58575 Laps tot hyst resj mal C 00000 64912 Nrv rpr w/nrv algrft 1st J1 05432 64913 Nrv rpr w/nrv algrft ea addl N 00000 71045 X-ray exam chest 1 view Q3 05521 71046 X-ray exam chest 2 views Q3 05521 71047 X-ray exam chest 3 views Q1 05521 71048 X-ray exam chest 4+ views Q1 05522 74018 X-ray exam abdomen 1 view Q1 05521 74019 X-ray exam abdomen 2 views Q1 05522 74021 X-ray exam abdomen 3+ views Q1 05522 81105 Hpa-1 genotyping A 00000 81106 Hpa-2 genotyping A 00000 81107 Hpa-3 genotyping A 00000 81108 Hpa-4 genotyping A 00000 81109 Hpa-5 genotyping A 00000 81110 Hpa-6 genotyping A 00000 81111 Hpa-9 genotyping A 00000 81112 Hpa-15 genotyping A 00000 81120 Idh1 common variants A 00000 81121 Idh2 common variants A 00000 81175 Asxl1 full gene sequence A 00000 81176 Asxl1 gene target seq alys A 00000 81230 Cyp3a4 gene common variants A 00000 81231 Cyp3a5 gene common variants A 00000 81232 Dpyd gene common variants A 00000 81238 F9 full gene sequence A 00000 81247 G6pd gene alys cmn variant A 00000 81248 G6pd known familial variant A 00000 81249 G6pd full gene sequence A 00000 81258 Hba1/hba2 gene fam vrnt A 00000

8 HCPCS CodeDesc SI APC Edit ActivDate TermDate 81259 Hba1/hba2 full gene sequence A 00000 81269 Hba1/hba2 gene dup/del vrnts A 00000 81283 Ifnl3 gene A 00000 81328 Slco1b1 gene com variants A 00000 81334 Runx1 gene targeted seq alys A 00000 81335 Tpmt gene com variants A 00000 81346 Tyms gene com variants A 00000 81361 Hbb gene com variants A 00000 81362 Hbb gene known fam variant A 00000 81363 Hbb gene dup/del variants A 00000 81364 Hbb full gene sequence A 00000 81448 Hrdtry perph neurphy panel A 00000 81520 Onc breast mrna 58 genes A 00000 81521 Onc breast mrna 70 genes A 00000 81541 Onc prostate mrna 46 genes A 00000 81551 Onc prostate 3 genes A 00000 86008 Allg spec ige recomb ea Q4 00000 86794 Zika virus igm antibody Q4 00000 87634 Rsv dna/rna amp probe Q4 00000 87662 Zika virus dna/rna amp probe Q4 00000 90756 Cciiv4 vacc abx free im L 00000 93792 Pt/caregiver trainj home inr B 00000 62 93793 Anticoag mgmt pt warfarin B 00000 62 94617 Exercise tst brncspsm Q1 05734 94618 Pulmonary stress testing Q1 05734 95249 Cont gluc mntr pt prov eqp S 05733 96573 Pdt dstr prmlg les phys/qhp Q1 05051 96574 Dbrdmt prmlg les w/pdt Q1 05051 97127 Ther ivntj w/focus cog funcj E1 00000 28 97763 Orthc/prostc mgmt sbsq enc A 00000 99483 Assmt & care pln pt cog imp S 05822 99484 Care mgmt svc bhvl hlth cond S 05821 99492 1st psyc collab care mgmt S 05822 99493 Sbsq psyc collab care mgmt S 05822 99494 1st/sbsq psyc collab care N 00000 C9014 Injection, cerliponase alfa G 09014 55 C9015 C-1 esterase, haegarda G 09015 55 C9016 Inj, triptorelin ext rel G 09016 55 C9024 Inj, daunorubicin-cytarabine G 09302 55 C9028 Inj. inotuzumab ozogamicin G 09028 55 C9029 Injection, guselkumab G 09029 55 C9738 Blue light cysto imag agent N 00000 55 C9748 Prostatic rf water vapor tx J1 05373 55 D0411 Hba1c in office testing E1 00000 50 D5511 Rep broke comp dent base man E1 00000 50 D5512 Rep broke comp dent base max E1 00000 50 D5611 Rep resin part dent base man E1 00000 50 D5612 Rep resin part dent base max E1 00000 50 D5621 Rep cast part frame man E1 00000 50 D5622 Rep cast part frame max E1 00000 50 D6096 Remove broken imp ret screw E1 00000 50

9 HCPCS CodeDesc SI APC Edit ActivDate TermDate D6118 Imp/abut int fixed dent man E1 00000 9 D6119 Int/abut int fixed dent max E1 00000 9 D7296 Corticotomy, 1-3 teeth E1 00000 50 D7297 Corticotomy, 4 or more teeth E1 00000 50 D7979 Non-surgical sialolithotomy E1 00000 28 D8695 Remove fixed ortho appliance E1 00000 50 D9222 Deep anest, 1st 15 min E1 00000 28 D9239 Iv mod sedation, 1st 15 min E1 00000 28 D9995 Teledentistry real-time E1 00000 28 D9996 Teledentistry dent review E1 00000 28 E0953 W/c lateral thigh/knee sup Y 00000 61 E0954 Foot box, any type each foot Y 00000 61 G0511 Ccm/bhi by rhc/fqhc 20min mo A 00000 G0512 Cocm by rhc/fqhc 60 min mo A 00000 G0513 Prolong prev svcs, first 30m N 00000 G0514 Prolong prev svcs, addl 30m N 00000 G0515 Cognitive skills development A 00000 G0516 Insert drug del implant, >4 Q1 05735 G0517 Remove drug implant Q1 05735 G0518 Remove w insert drug implant Q1 05735 G9868 Next Gen ACO model <10min B 00000 62 G9869 Next Gen ACO model 10-20min B 00000 62 G9870 Next Gen ACO model >20min B 00000 62 G9890 Mac exam perf M 00000 72 G9891 Doc med rsn no dil mac exam M 00000 72 G9892 Doc pt rsn no dil mac exam M 00000 72 G9893 No mac exam M 00000 72 G9894 Adr dep thrpy prescribed M 00000 72 G9895 Doc med rsn no adr dep thrpy M 00000 72 G9896 Doc pt rsn no adr dep thrpy M 00000 72 G9897 Pt nt prsc adr dep thrpy rng M 00000 72 G9898 Snp/lg trm cre pt w/pos cde M 00000 72 G9899 Scrn mam perf rslts doc M 00000 72 G9900 Scrn mam perf rslts not doc M 00000 72 G9901 Snp/lg trm cre pt w/pos cde M 00000 72 G9902 Pt scrn tbco and id as user M 00000 72 G9903 Pt scrn tbco id as non user M 00000 72 G9904 Doc med rsn no tbco scrn M 00000 72 G9905 No pt tbco scrn rng M 00000 72 G9906 Pt recv tbco cess interv M 00000 72 G9907 Doc med rsn no tbco interv M 00000 72 G9908 No pt tbco cess interv rng M 00000 72 G9909 Doc med rsn no tbco interv M 00000 72 G9910 Snp/lg trm cre pt w/pos cde M 00000 72 G9911 Node neg pre/post syst ther M 00000 72 G9912 Hbv status assesed and int M 00000 72 G9913 No hbv status assesd and int M 00000 72 G9914 Pt receiving anti-tnf agent M 00000 72 G9915 No documntd hbv results rcd M 00000 72 G9916 Funct status past 12 months M 00000 72 G9917 Doc med rsn no funct status M 00000 72

10 HCPCS CodeDesc SI APC Edit ActivDate TermDate G9918 No funct stat perf, rsn nos M 00000 72 G9919 Scrn nd pos nd prov of rec M 00000 72 G9920 Scrning perf and negative M 00000 72 G9921 No or part scrn nd rng or os M 00000 72 G9922 Sfty cncrns scrn nd mit recs M 00000 72 G9923 Safty cncrns scrn and neg M 00000 72 G9924 Doc med rsn no scrn or recs M 00000 72 G9925 No scrn prov rsn nos M 00000 72 G9926 Sfty cncrns scrn but no recs M 00000 72 G9927 Doc no warf /fda pt trial M 00000 72 G9928 No warf or fda drug presc M 00000 72 G9929 Trs/rev af M 00000 72 G9930 Com care M 00000 72 G9931 No chad or chad scr 0 or 1 M 00000 72 G9932 Doc pt rsn no tb scrn recrds M 00000 72 G9933 Canc detectd during col scrn M 00000 72 G9934 Doc rsn not detecting cancer M 00000 72 G9935 Canc not detectd during srcn M 00000 72 G9936 Pmh plyp/neo co/rect/jun/ans M 00000 72 G9937 Dig or surv colsco M 00000 72 G9938 Snp/lg trm cre pt w/pos cde M 00000 72 G9939 Same path/derm perf biopsy M 00000 72 G9940 Doc reas no statin therapy M 00000 72 G9941 Pre and post vas wthn 3 mos M 00000 72 G9942 Adtl spine proc on same date M 00000 72 G9943 Bk pn nt msr vas scl pre/pst M 00000 72 G9944 Vas 3 mon pre and 1 yr post M 00000 72 G9945 Pt w/cancer scoliosis M 00000 72 G9946 Bk pn nt msr vas pre-pst 1y M 00000 72 G9947 Pre and post vas wthn 3 mos M 00000 72 G9948 Adtl spine proc on same date M 00000 72 G9949 Lg pn nt msr vas scl pre/pst M 00000 72 G9954 Pt >2 rsk fac post-op vomit M 00000 72 G9955 Inhlnt anesth only for induc M 00000 72 G9956 Combo thrpy of >= 2 prophly M 00000 72 G9957 Doc med rsn no combo thrpy M 00000 72 G9958 No combo prohpyl thrp for pt M 00000 72 G9959 Systemic antimicro not presc M 00000 72 G9960 Med rsn sys antimi nt rx M 00000 72 G9961 Systemic antimicro presc M 00000 72 G9962 Embolization doc separatly M 00000 72 G9963 Embolization not doc separat M 00000 72 G9964 Pt recv >=1 well-chld visit M 00000 72 G9965 No well-chld vist recv by pt M 00000 72 G9966 Scrn, inter, report child M 00000 72 G9967 No scrn, inter, reprt child M 00000 72 G9968 Pt refrd 2 pvdr/spclst in pp M 00000 72 G9969 Pvdr rfrd pt rprt rcvd M 00000 72 G9970 Pvdr rfrd pt no rprt rcvd M 00000 72 G9974 Dil mac exam performed M 00000 72 G9975 Doc med rsn no mac exm perf M 00000 72

11 HCPCS CodeDesc SI APC Edit ActivDate TermDate G9976 Doc pat rsn no mac exm perf M 00000 72 G9977 Dil mac exam no perf rsn nos M 00000 72 J0565 Inj, bezlotoxumab, 10 mg G 09490 J0604 Cinacalcet, esrd on dialysis B 00000 62 J0606 Inj, etelcalcetide, 0.1 mg K 09031 J1428 Inj, eteplirsen, 10 mg G 09484 J1555 Inj cuvitru, 100 mg K 09034 J1627 Inj, granisetron, xr, 0.1 mg G 09486 J1726 Makena, 10 mg K 09074 J1729 Inj hydroxyprogst capoat nos N 00000 J2326 Inj, nusinersen, 0.1mg G 09489 J2350 Injection, ocrelizumab, 1 mg G 09494 J3358 Ustekinumab, iv inject, 1 mg G 09487 J7210 Inj, afstyla, 1 i.u. G 09043 J7211 Inj, kovaltry, 1 i.u. K 09075 J7296 Kyleena, 19.5 mg E1 00000 50 J7345 Aminolevulinic acid, 10% gel G 09301 J9022 Inj, atezolizumab,10 mg G 09483 J9023 Injection, avelumab, 10 mg G 09491 J9203 Gemtuzumab ozogamicin 0.1 mg G 09495 J9285 Inj, olaratumab, 10 mg G 09485 L3761 Eo, adj lock joint prefab ot A 00000 L7700 Pros soc insert gasket/seal A 00000 L8625 Charger coch impl/aoi battry A 00000 L8694 Aoi transducer/actuator repl A 00000 P9073 Platelets, pathogen reduced R 09536 P9100 Pathogen test for platelets S 01493 Q0477 Pwr module pt cable lvad rpl A 00000 Q2040 Tisagenlecleucel car-pos t K 09081 Q4176 Neopatch, per sq centimeter N 00000 Q4177 Floweramnioflo, 0.1 cc N 00000 Q4178 Floweramniopatch, per sq cm N 00000 Q4179 Flowerderm, per sq cm N 00000 Q4180 Revita, per sq cm N 00000 Q4181 Amnio wound, per square cm N 00000 Q4182 Transcyte, per sq centimeter N 00000

Deleted HCPCS/CPT Procedure Codes

The following HCPCS/CPT code(s) were deleted from the IOCE, effective 01-01-18 HCPCS CodeDesc 0051T Implant total heart system 0052T Replace thrc unit hrt syst 0053T Replace implantable hrt syst 00740 Anesth upper gi visualize 00810 Anesth low intestine scope 01180 Anesth pelvis nerve removal 01190 Anesth pelvis nerve removal 01682 Anesth airplane cast

12 HCPCS CodeDesc 0178T 64 lead ecg w/i&r 0179T 64 lead ecg w/tracing 0180T 64 lead ecg w/i&r only 0255T Evasc rpr iliac art bifr s&i 0293T Ins lt atrl press monitor 0294T Ins lt atrl mont pres lead 0299T Esw wound healing init wound 0300T Esw wound healing addl wound 0301T Mw therapy for breast tumor 0302T Icar ischm mntrng sys compl 0303T Icar ischm mntrng sys eltrd 0304T Icar ischm mntrng sys device 0305T Icar ischm mntrng prgrm eval 0306T Icar ischm mntr interr eval 0307T Rmvl icar ischm mntrng dvce 0309T Prescrl fuse w/ instr l4/l5 0310T Motor function mapping ntms 0340T Ablate pulm tumors + extnsn 0438T Tprnl plmt biodegrdabl matrl 15732 Muscle-skin graft head/neck 29582 Apply multlay comprs upr leg 29583 Apply multlay comprs upr arm 31320 Diagnostic incision larynx 34800 Endovas aaa repr w/sm tube 34802 Endovas aaa repr w/2-p part 34803 Endovas aaa repr w/3-p part 34804 Endovas aaa repr w/1-p part 34805 Endovas aaa repr w/long tube 34806 Aneurysm press sensor add-on 34825 Endovasc extend prosth init 34826 Endovasc exten prosth addl 34900 Endovasc iliac repr w/graft 36120 Establish access to artery 36515 Apheresis adsorp/reinfuse 55450 Ligation of sperm duct 64565 Implant neuroelectrodes 69820 Establish inner ear window 69840 Revise inner ear window 71010 Chest x-ray 1 view frontal 71015 Chest x-ray stereo frontal 71020 Chest x-ray 2vw frontal&latl 71021 Chest x-ray frnt lat lordotc 71022 Chest x-ray frnt lat oblique 71023 Chest x-ray and fluoroscopy 71030 Chest x-ray 4/> views 71034 Chest x-ray&fluoro 4/> views 71035 Chest x-ray special views 74000 X-ray exam of abdomen 74010 X-ray exam of abdomen 74020 X-ray exam of abdomen 75658 Artery x-rays arm

13 HCPCS CodeDesc 75952 Endovasc repair abdom aorta 75953 Abdom aneurysm endovas rpr 75954 Iliac aneurysm endovas rpr 77422 Neutron beam tx simple 78190 Platelet survival kinetics 83499 Assay of progesterone 20- 84061 Phosphatase forensic exam 86185 Counterimmunoelectrophoresis 86243 Fc receptor 86378 Migration inhibitory factor 86729 Lympho venereum antibody 86822 Lymphocyte culture primed 87277 Legionella micdadei ag if 87470 Bartonella dna dir probe 87477 Lyme dis dna quant 87515 Hepatitis b dna dir probe 88154 Cytopath c/v select 93982 Aneurysm pressure sens study 94620 Pulmonary stress test/simple 97532 Cognitive skills development 97762 C/o for orthotic/prosth use 99363 Anticoagulant mgmt initial 99364 Anticoagulant mgmt subseq A9599 Radioph dx b amyloid pet nos C9140 Afstyla factor viii recomb C9483 Injection, atezolizumab C9484 Injection, eteplirsen C9485 Injection, olaratumab C9486 Inj, granisetron ext C9489 Injection, nusinersen C9490 Injection, bezlotoxumab C9491 Injection, avelumab C9494 Injection, ocrelizumab D5510 Dentur repr broken compl bas D5610 Dentures repair resin base D5620 Rep part denture cast frame G0202 Scr mammo bi incl cad G0204 Dx mammo incl cad bi G0206 Dx mammo incl cad uni G0364 Bone marrow aspirate &biopsy G0502 Init psych care manag, 70min G0503 Subseq psych care man,60mi G0504 Init/sub psych care add 30 m G0505 Cog/func assessment outpt G0507 Care manage serv minimum 20 G8696 Antithromb thx presc G8697 Antithromb no presc doc reas G8698 Antithromb no presc no reas G8879 Node neg inv brst cncr G8947 1 or more neuropsych G8971 Warfrn or othr antcog no rx

14 HCPCS CodeDesc G8972 1>=risk or>= mod risk for te G9381 Doc med reas no offer eol G9496 Doc rsn no adeno/neopl detec J1725 Hydroxyprogesterone caproate J9300 Gemtuzumab ozogamicin inj P9072 Plate path red/rapid bac tes Q9984 Kyleena Q9985 Inj, hydroxyprogesterone, NOS Q9986 Inj, Makena Q9987 Pathogen test for platelets Q9988 Platelets pheresis path reduc Q9989 Ustekinumab IV Inj, 1 mg

HCPCS Description Changes

The following code descriptions were changed, effective 01-01-18 HCPCS Old Description New Description 0465T Supchrdl njx rxw/o supply Supchrdl njx rx w/o supply 0466T Insj chwal respir eltrd/ra Insj ch wal respir eltrd/ra 0468T Rmvl chwal respir eltrd/ra Rmvl ch wal respir eltrd/ra 11403 Exc tr-ext b9+marg 2.1-3cm/< Exc tr-ext b9+marg 2.1-3cm 14302 Tis trnfr addl 30 sq cm/< Tis trnfr addl 30 sq cm 17250 Chemical cautery tissue Chem caut of granltj tissue 31254 Revision of ethmoid sinus Nsl/sins ndsc w/prtl ethmdct 31255 Removal of ethmoid sinus Nsl/sins ndsc w/tot ethmdct 31276 Sinus endoscopy surgical Nsl/sins ndsc frnt tiss rmvl 31645 Bronchoscopy clear airways Brnchsc w/ther aspir 1st 31646 Bronchoscopy reclear airway Brnchsc w/ther aspir sbsq 32998 Perq rf ablate tx pul tumor Ablate pulm tumor perq rf 34812 Xpose for endoprosth femorl Opn fem art expos 34820 Xpose for endoprosth iliac Opn iliac art expos 34833 Xpose for endoprosth iliac Opn ilac art expos cndt crtj 34834 Xpose endoprosth brachial Opn brach art expos 3496F Cd4+ cell count + 500 cells Cd4+ cell count >= 500 cells 36140 Establish access to artery Intro ndl icath upr/lxtr art 36468 Injection(s) spider veins Njx sclrsnt spider veins 36470 Injection therapy of vein Njx sclrsnt 1 incmptnt vein 36471 Injection therapy of veins Njx sclrsnt mlt incmptnt vn 36516 Apheresis selective Apheresis immunoads slctv 38220 Bone marrow aspiration Dx bone marrow aspirations 38221 Bone marrow biopsy Dx bone marrow biopsies 43112 Removal of esophagus Esphg tot w/thrcm 57240 Repair bladder & vagina Anterior colporrhaphy 57260 Repair of vagina Cmbn ant pst colprhy 57265 Extensive repair of vagina Cmbn ap colprhy w/ntrcl rpr 62290 Inject for spine disk x-ray Njx px discography lumbar 62291 Inject for spine disk x-ray Njx px discography crv/thrc 62292 Injection into disk lesion Njx chemonucleolysis lmbr 64550 Apply neurostimulator Appl surface neurostimulator

15 HCPCS Old Description New Description 76000 Fluoroscope examination Fluoroscopy <1 hr phys/qhp 76098 X-ray exam breast specimen X-ray exam surgical specimen 76881 Us xtr non-vasc complete Us compl joint r-t w/img 76882 Us xtr non-vasc lmtd Us lmtd jt/nonvasc xtr strux 81439 Inherited cardmypthy 5 gns Hrdtry cardmypy gene panel 82042 Assay of urine albumin Other source albumin quan ea 82043 Microalbumin quantitative Ur albumin quantitative 82044 Microalbumin semiquant Ur albumin semiquantitative 86003 Allergen specific ige Allg spec ige crude xtrc ea 86005 Allergen specific ige Allg spec ige multiallg scr 90620 Menb rp w/omv vaccine im Menb-4c vacc 2 dose im 90621 Menb rlp vaccine im Menb-fhbp vacc 2/3 dose im 90651 9vhpv vaccine 3 dose im 9vhpv vaccine 2/3 dose im 92602 Reprogram cochlear implt 7/> Reprogram cochlear implt <7 94621 Pulm stress test/complex Cardiopulm exercise testing 95250 Glucose monitoring cont Cont gluc mntr phys/qhp eqp 95251 Gluc monitor cont phys i&r Cont gluc mntr analysis i&r 95930 Visual evoked potential test Visual ep test cns w/i&r 96567 Photodynamic tx skin Pdt dstr prmlg les skn 97760 Orthotic mgmt and training Orthotic mgmt&trainj 1st enc 97761 Prosthetic training Prosthetic trainj 1st enc C9488 Conivaptan HCL Conivaptan hcl C9747 Ablation, HIFU, prostate Ablation, hifu, prostate D1354 Interim caries med app Int caries med app per tooth D2740 Crown porcelain/ceramic subs Crown porcelain/ceramic D3320 End thxpy, bicuspid tooth End thxpy, premolar tooth D3330 End thxpy, molar End thxpy, molar tooth D3347 Retreat root canal bicuspid Retreat root canal premolar D3421 Root surgery bicuspid Root surgery premolar D7980 Sialolithotomy Surgical sialolithotomy D9223 General anesthesia each 15m General anesth ea addl 15 mi D9243 Iv sedation each 15m Iv sedation ea addl 15m E1639 Dialysis scale Scale, each G8430 Pt inelig med check Ec at doc medrec pt not elig G8433 Scr dep not done, doc rsn Scr for dep not cpt doc rsn G8442 Pt inelig pain assessment Doc pain as nt perf, not elg G8535 Pt inelig no eld mal scrn Eld maltreatment not doc G8540 Pt inelig funct assess Foa not doc as being perf G8808 No transab or transvag us Ultrasound not perf, rng G8869 Doc immun hep b 1st antitnf Doc immune hep b antitnf G8880 Doc reas no lymph node biop Sen lym p node biop not perf G8938 Bmi calc, pt no f/u plan elg Bmi doc onl fup nt doc G8939 Pain assess doc, f/u no doc Pain as doc positive, no f/u G8941 No doc elder scrn, pt no el Eld maltreatment doc as pos G8967 Wrfrn or oral antigoag pres Warf or other fda drug presc G8968 Doc rsn no warf/anticog pres Doc med not presb G8969 Pt rsn no pres wrfrn or othr Doc pt rsn no presc warf/fda G9227 Docrsn no care plan Foa doc, care plan not doc G9256 Doc death after cas Doc of pat death after cas G9257 Doc stroke after cas Doc of pat stroke after cas G9258 Doc stroke after cea Doc of pat stroke after cea

16 HCPCS Old Description New Description G9259 Doc surv no stroke after cas Survive/no stroke post cas G9260 Doc death after cea Doc of pat death after cea G9261 Doc surv no stroke after cea Survive/no stroke post cea G9262 Doc death in hosp aaa repair Doc of death post-aaa repair G9263 Doc surv in hosp aaa repair Doc of disch post-aaa repair G9313 Docrsn not first line amox Amoxic not presc as 1st line G9348 Docrsn no sinus ct dx Doc rsn for ord ct scan G9384 Doc med reas no ann srn hcv Doc med rsn no hcv scrn G9504 Doc reas no hbv status Doc rsn hep b stat not asses G9541 Filter gone aft 3mos placmt Filter rem 3 mon plmt G9607 Doc rsn no interop cysto Doc med rsn not perf cystosc G9624 No etoh scr/no counc/nrg Pt not scrn or no counseling G9637 Doc >1 dose reduc tech >= 2 same hi-rsk med ord G9638 No doc >1 dose reduc tech >= 2 same hi-rsk med not ord G9656 Pt direct anesth loc to pacu Pt trans from anest to pacu G9716 Bmi not norm, no follow, doc Bmi doc onl fup not cmpltd G9717 Doc dx depr/dx bipol, no scr Doc pt dx dep/bp f/u nt req G9744 Pt not elig, dx htn Pt not eli d/t act dig htn G9745 Doc rsn no scr high bp Doc rsn no hbp scrn or f/u G9758 Hospice or term phase Pt in hos G9762 Pt had hpv b/t 9-13 yr Pt had >= 2-3 hpv vaccines G9763 Pt no hpv b/t 9-13 yr Pt not have 2-3 hpv vaccines G9764 Pt tx oral syst/bio med psor Pt treatd w/oral syst or bio G9765 Pt decl chan/conind or <6m Doc pat declined therapy G9784 Path/derm 2nd opin bx Path/derm prov 2nd biop opin G9785 Path rpt snt path/derm in 7d Pathology report sent G9786 No path rpt sent in 7d Pathology report not sent G9794 Doc med rsn no asa/antiplat Doc med rsn no daily aspirin G9814 Death occ dur hospitaliz Death during index hosp G9815 No death occ dur hospitaliz Death not during index hosp G9816 Death occ 30d post proc Death <30 day post discharge G9817 No death occ 30d post proc No death 30-days post-disch G9840 Kras tst bfr beg anti moab Gene testing performed G9841 No kras tst bfr beg ant moab Gene testing not performed G9843 Kras gene mut Kras or nras gene mutation J2274 In morphine preservativ free Inj morphine pf epid ithc J3010 Fentanyl citrate injeciton Fentanyl citrate injection J3060 Inj, taliglucerace alfa 10 u Inj, taliglucerase alfa 10 u J7321 Hyalgan/supartz inj per dose Hyalgan supartz visco-3 dose J7328 Gel-syn injection 0.1 mg Gelsyn-3 injection 0.1 mg L3760 Eo withjoint, prefabricated Eo adj jt prefab custom fit L8691 Osseointegrated snd proc rpl Aoi snd proc repl excl actua Q4132 Grafix core Grafix core, grafixpl core Q4133 Grafix prime Grafix prime grafix pl prime Q4148 Neox 1k, 1cm Neox neox rt or clarix cord Q4156 Neox 100 1 square cm Neox 100 or clarix 100 Q4158 Marigen 1 square cm Kerecis omega3, per sq cm Q4162 Amnio bio and woundex flow Wndex flw, bioskn flw, 0.5cc Q4163 Amnio bio and woundex sq cm Woundex, bioskin, per sq cm

17 HCPCS Changes- APC, Status Indicator and/or Edit Assignments

The following code(s) had an APC and/or SI and/or edit change, effective 04-01-17 **A blank in the field indicates no change. HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 0421T Waterjet prostate abltj cmpl 00000 05374 E1 J1 9 N/A

The following code(s) had an APC and/or SI and/or edit change, effective 01-01-18 **A blank in the field indicates no change. HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 0100T Prosth retina receive&gen 01906 01904 0198T Ocular blood flow measure 05733 05734 0388T Leadless c pm remove ventr 05182 05183 0398T Mrgfus strtctc les abltj 01537 01576 0402T Collagen crosslinking cornea 05502 05503 T J1 0421T Waterjet prostate abltj cmpl 00000 05375 E1 J1 9 N/A 11740 Drain blood from under nail 05733 05734 1175F Function stat assessed rvwd M E1 72 9 1181F Neuropsychia sympts M E1 72 9 assessed 12016 Rpr fe/e/en/l/m 12.6-20.0 cm 05051 05052 12037 Intmd rpr s/tr/ext >30.0 cm 05055 05054 12051 Intmd rpr face/mm 2.5 cm/< 05051 05052 12057 Intmd rpr face/mm >30.0 cm 05051 05052 14350 Filleted finger/toe flap 05055 05054 15130 Derm autograft trnk/arm/leg 05055 05054 15150 Cult skin grft t/arm/leg 05055 05054 15200 Skin full graft trunk 05055 05054 15610 Delay flap arms/legs 05055 05054 15736 Muscle-skin graft arm 05055 05054 15783 Dermabrasion suprfl any site 05051 05052 15821 Revision of lower eyelid 05055 05054 15852 Dressing change not for burn 05735 05053 15945 Remove hip pressure sore 05055 05054 15946 Remove hip pressure sore 05055 05054 15952 Remove thigh pressure sore 05055 05054 2019F Dilated macul exam done M E1 72 9 20555 Place ndl musc/tis for rt 05113 05112 20822 Replantation digit complete 05113 05112 20922 Removal of fascia for graft 05055 05054 20979 Us bone stimulation 05732 05731 24357 Repair elbow perc 05113 05112 24566 Treat humerus fracture 05113 05112 25025 Decompress forearm 2 05113 05112 spaces 25100 Biopsy of wrist joint 05113 05112 25112 Reremove wrist tendon 05113 05112 lesion 25118 Excise wrist tendon sheath 05113 05112 25125 Remove/graft forearm lesion 05113 05112 25248 Remove forearm foreign 05113 05112

18 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit body 26025 Drainage of palm bursa 05113 05112 26035 Decompress fingers/hand 05113 05112 26037 Decompress fingers/hand 05113 05112 26200 Remove hand bone lesion 05113 05112 26250 Extensive hand surgery 05113 05112 26262 Resect distal finger tumor 05113 05112 26410 Repair hand tendon 05113 05112 26418 Repair finger tendon 05113 05112 26437 Realignment of tendons 05113 05112 26474 Fusion of finger tendons 05113 05112 26476 Tendon lengthening 05113 05112 26499 Revision of finger 05113 05112 26525 Release finger contracture 05113 05112 26591 Repair muscles of hand 05113 05112 26607 Treat metacarpal fracture 05113 05112 26991 Drainage of pelvis bursa 05113 05112 27000 Incision of hip tendon 05113 05112 27098 Transfer tendon to pelvis 05113 05112 27267 Cltx thigh fx 05113 05112 27447 Total knee arthroplasty 00000 05115 C J1 27604 Drain lower leg bursa 05113 05112 27860 Fixation of ankle joint 05113 05112 28002 Treatment of foot infection 05113 05112 28024 Exploration of toe joint 05113 05112 28090 Removal of foot lesion 05113 05112 28124 Partial removal of toe 05113 05112 28126 Partial removal of toe 05113 05112 28220 Release of foot tendon 05113 05112 28261 Revision of foot tendon 05113 05112 28286 Repair of hammertoe 05113 05112 28340 Resect enlarged toe tissue 05113 05112 28345 Repair webbed toe(s) 05113 05112 28455 Treat midfoot fracture each 05113 05112 28636 Treat toe dislocation 05113 05112 28820 Amputation of toe 05113 05112 28825 Partial amputation of toe 05113 05112 29240 Strapping of shoulder 05733 05734 29530 Strapping of knee 05733 05734 3014F Screen mammo doc rev M E1 72 9 30915 Ligation nasal sinus artery 05182 05183 30920 Ligation upper jaw artery 05182 05183 32551 Insertion of chest tube 05181 05182 32557 Insert cath pleura w/ image 05181 05182 33010 Drainage of heart sac 05181 05182 33011 Repeat drainage of heart sac 05181 05182 33215 Reposition pacing-defib lead 05182 05183 33226 Reposition l ventric lead 05182 05183 34101 Removal of artery clot 05183 05184 34111 Removal of arm artery clot 05183 05184 34201 Removal of artery clot 05183 05184

19 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 34203 Removal of leg artery clot 05183 05184 34421 Removal of vein clot 05182 05183 34490 Removal of vein clot 05182 05183 34501 Repair valve femoral vein 05183 05184 34510 Transposition of vein valve 05183 05184 34520 Cross-over vein graft 05183 05184 34530 Leg vein fusion 05182 05183 35011 Repair defect of artery 05183 05184 35045 Repair defect of arm artery 05183 05184 3517F Hbv assess&results intrp 1yr M E1 72 9 35184 Repair blood vessel lesion 05182 05183 35188 Repair blood vessel lesion 05183 05184 35190 Repair blood vessel lesion 05183 05184 35201 Repair blood vessel lesion 05183 05184 35206 Repair blood vessel lesion 05182 05183 35207 Repair blood vessel lesion 05182 05183 35231 Repair blood vessel lesion 05182 05183 35236 Repair blood vessel lesion 05183 05184 35256 Repair blood vessel lesion 05183 05184 35261 Repair blood vessel lesion 05182 05183 35266 Repair blood vessel lesion 05183 05184 35286 Repair blood vessel lesion 05183 05184 35321 Rechanneling of artery 05183 05184 35761 Exploration of artery/vein 05182 05183 35860 Explore limb vessels 05182 05183 35875 Removal of clot in graft 05183 05184 35876 Removal of clot in graft 05183 05184 35879 Revise graft w/vein 05183 05184 35881 Revise graft w/vein 05183 05184 35883 Revise graft w/nonauto graft 05183 05184 35884 Revise graft w/vein 05183 05184 35903 Excision graft extremity 05182 05183 36221 Place cath thoracic aorta 05182 05183 36222 Place cath carotid/inom art 05182 05183 36223 Place cath carotid/inom art 05183 05184 36224 Place cath carotd art 05183 05184 36225 Place cath subclavian art 05182 05183 36226 Place cath vertebral art 05183 05184 36251 Ins cath ren art 1st unilat 05182 05183 36252 Ins cath ren art 1st bilat 05182 05183 36253 Ins cath ren art 2nd+ unilat 05183 05184 36254 Ins cath ren art 2nd+ bilat 05182 05183 36260 Insertion of infusion pump 05183 05184 36473 Endovenous mchnchem 1st 05182 05183 vein 36475 Endovenous rf 1st vein 05182 05183 36478 Endovenous laser 1st vein 05182 05183 36555 Insert non-tunnel cv cath 05181 05182 36556 Insert non-tunnel cv cath 05181 05182 36557 Insert tunneled cv cath 05183 05184 36558 Insert tunneled cv cath 05182 05183

20 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 36560 Insert tunneled cv cath 05182 05183 36561 Insert tunneled cv cath 05182 05183 36563 Insert tunneled cv cath 05183 05184 36565 Insert tunneled cv cath 05182 05183 36566 Insert tunneled cv cath 05183 05184 36569 Insert picc cath 05181 05182 36570 Insert picvad cath 05182 05183 36571 Insert picvad cath 05182 05183 36576 Repair tunneled cv cath 05181 05182 36578 Replace tunneled cv cath 05182 05183 36580 Replace cvad cath 05181 05182 36581 Replace tunneled cv cath 05182 05183 36582 Replace tunneled cv cath 05182 05183 36583 Replace tunneled cv cath 05183 05184 36584 Replace picc cath 05181 05182 36585 Replace picvad cath 05182 05183 36595 Mech remov tunneled cv cath 05182 05183 36596 Mech remov tunneled cv cath 05181 05182 36597 Reposition venous catheter 05181 05182 36600 Withdrawal of arterial blood 05733 05734 36640 Insertion catheter artery 05182 05183 36800 Insertion of cannula 05183 05184 36810 Insertion of cannula 05182 05183 36815 Insertion of cannula 05183 05184 36818 Av fuse uppr arm cephalic 05183 05184 36819 Av fuse uppr arm basilic 05183 05184 36820 Av fusion/forearm vein 05183 05184 36821 Av fusion direct any site 05182 05183 36825 Artery-vein autograft 05183 05184 36830 Artery-vein nonautograft 05183 05184 36831 Open thrombect av fistula 05183 05184 36832 Av fistula revision open 05183 05184 36833 Av fistula revision 05183 05184 36835 Artery to vein shunt 05182 05183 36838 Dist revas ligation hemo 05183 05184 36861 Cannula declotting 05183 05184 37184 Prim art m-thrmbc 1st vsl 05183 05192 T J1 37187 Venous mech thrombectomy 05183 05192 T J1 37188 Venous m-thrombectomy 05182 05183 add-on 37191 Ins endovas vena cava filtr 05183 05184 37192 Redo endovas vena cava filtr 05182 05183 37193 Rem endovas vena cava filter 05182 05183 37197 Remove intrvas foreign body 05182 05183 37200 Transcatheter biopsy 05183 05184 37211 Thrombolytic art therapy 05183 05184 37212 Thrombolytic venous therapy 05182 05183 37213 Thromblytic art/ven therapy 05181 05182 37214 Cessj therapy cath removal 05181 05182 37500 Endoscopy ligate perf veins 05183 05184 37565 Ligation of neck vein 05181 05182

21 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 37600 Ligation of neck artery 05182 05183 37605 Ligation of neck artery 05182 05183 37606 Ligation of neck artery 05182 05183 37607 Ligation of a-v fistula 05182 05183 37615 Ligation of neck artery 05181 05182 37619 Ligation of inf vena cava 05183 05184 37650 Revision of major vein 05182 05183 37700 Revise leg vein 05182 05183 37718 Ligate/strip short leg vein 05182 05183 37722 Ligate/strip long leg vein 05182 05183 37735 Removal of leg veins/lesion 05182 05183 3775F Adenoma detected screening M E1 72 9 37760 Ligate leg veins radical 05182 05183 37761 Ligate leg veins open 05181 05182 37765 Stab phleb veins xtr 10-20 05182 05183 37766 Phleb veins - extrem 20+ 05182 05183 3776F Adenoma not detect M E1 72 9 screening 37780 Revision of leg vein 05181 05182 37785 Ligate/divide/excise vein 05182 05183 40804 Removal foreign body mouth 05735 05301 41250 Repair tongue laceration 05735 05734 4164F Adjv hrmnl thxpy rxd M E1 72 9 42960 Control throat bleeding 05161 05162 43210 Egd esophagogastrc 05331 05362 fndoplsty 43282 Lap paraesoph her rpr 00000 05362 C J1 w/mesh 43772 Lap rmvl gastr adj device 00000 05303 C J1 43773 Lap replace gastr adj device 00000 05361 C J1 43774 Lap rmvl gastr adj all parts 00000 05303 C J1 4525F Neuropsychia interven order M E1 72 9 4526F Neuropsychia interven rcvd M E1 72 9 46601 Diagnostic anoscopy 05733 05734 46930 Destroy internal hemorrhoids 05311 05312 49419 Insert tun ip cath w/port 05183 05184 49422 Remove tunneled ip cath 05182 05183 49429 Removal of shunt 05182 05183 50396 Measure kidney pressure 05372 05373 T J1 50434 Convert nephrostomy 05372 05373 T J1 catheter 50435 Exchange nephrostomy cath 05372 05373 T J1 50543 Laparo partial nephrectomy 05377 05362 50574 Kidney endoscopy & biopsy 05372 05373 T J1 50970 Ureter endoscopy 05372 05373 T J1 50972 Ureter endoscopy & catheter 05372 05373 T J1 55866 Laparo radical prostatectomy 00000 05362 C J1 55875 Transperi needle place pros 05374 05375 Q3 J1 55920 Place needles pelvic for rt 05341 05415 56515 Destroy vulva lesion/s compl 05055 05054 56605 Biopsy of vulva/perineum 05412 05413

22 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 58301 Remove intrauterine device 05412 05411 58974 Transfer of embryo 05412 05413 6101F Safety counseling dementia M E1 72 9 6102F Safety counseling dem order M E1 72 9 62252 Csf shunt reprogram 05742 05743 62302 Myelography lumbar 05524 05573 injection 62303 Myelography lumbar 05524 05573 injection 62304 Myelography lumbar 05524 05573 injection 62305 Myelography lumbar 05524 05573 injection 64402 N block inj facial 05735 05734 68200 Treat eyelid by injection 05735 05734 70010 Contrast x-ray of brain 05524 05572 70015 Contrast x-ray of brain 05524 05573 70310 X-ray exam of teeth 05524 05523 70370 Throat x-ray & fluoroscopy 05522 05521 70380 X-ray exam of salivary gland 05522 05521 70552 Mri brain stem w/dye 05572 05571 70558 Mri brain w/dye 05572 05571 72083 X-ray exam entire spi 4/5 vw 05523 05522 72084 X-ray exam entire spi 6/> vw 05523 05522 72120 X-ray bend only l-s spine 05521 05522 72240 Myelography neck spine 05524 05573 72255 Myelography thoracic spine 05524 05573 72265 Myelography l-s spine 05524 05573 72270 Myelogphy 2/> spine regions 05524 05573 73010 X-ray exam of shoulder 05521 05522 blade 73040 Contrast x-ray of shoulder 05523 05572 73085 Contrast x-ray of elbow 05524 05572 73115 Contrast x-ray of wrist 05524 05571 73523 X-ray exam hips bi 5/> views 05523 05522 73525 Contrast x-ray of hip 05524 05572 73580 Contrast x-ray of knee joint 05524 05572 73615 Contrast x-ray of ankle 05524 05572 74178 Ct abd & pelv 1/> regns 05572 05571 74210 Contrst x-ray exam of throat 05522 05571 74220 Contrast x-ray esophagus 05522 05571 74240 X-ray upper gi delay w/o kub 05522 05571 74241 X-ray upper gi delay w/kub 05522 05571 74246 Contrst x-ray uppr gi tract 05522 05571 74247 Contrst x-ray uppr gi tract 05522 05571 74249 Contrst x-ray uppr gi tract 05523 05571 74270 Contrast x-ray exam of colon 05522 05571 74280 Contrast x-ray exam of colon 05522 05571 74283 Contrast x-ray exam of colon 05522 05571 74290 Contrast x-ray gallbladder 05522 05571 74400 Contrst x-ray urinary tract 05523 05571

23 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 74410 Contrst x-ray urinary tract 05523 05571 74415 Contrst x-ray urinary tract 05523 05571 74420 Contrst x-ray urinary tract 05524 05572 74425 Contrst x-ray urinary tract 05524 05571 74430 Contrast x-ray bladder 05523 05571 74712 Mri fetal sngl/1st gestation 05522 05523 74775 X-ray exam of perineum 05523 05522 75600 Contrast exam thoracic aorta 05182 05183 75605 Contrast exam thoracic aorta 05183 05184 75625 Contrast exam abdominl 05182 05183 aorta 75630 X-ray aorta leg arteries 05182 05183 75705 Artery x-rays spine 05183 05184 75710 Artery x-rays arm/leg 05182 05183 75716 Artery x-rays arms/legs 05182 05183 75726 Artery x-rays abdomen 05183 05184 75733 Artery x-rays adrenals 05182 05183 75736 Artery x-rays pelvis 05183 05184 75741 Artery x-rays lung 05182 05183 75743 Artery x-rays lungs 05182 05183 75746 Artery x-rays lung 05181 05182 75756 Artery x-rays chest 05182 05183 75805 Lymph vessel x-ray trunk 05181 05182 75807 Lymph vessel x-ray trunk 05182 05183 75810 Vein x-ray spleen/liver 05181 05182 75822 Vein x-ray arms/legs 05181 05182 75825 Vein x-ray trunk 05182 05183 75831 Vein x-ray kidney 05182 05183 75833 Vein x-ray kidneys 05182 05183 75840 Vein x-ray adrenal gland 05182 05183 75842 Vein x-ray adrenal glands 05183 05184 75860 Vein x-ray neck 05182 05183 75885 Vein x-ray liver 05182 05183 w/hemodynam 75887 Vein x-ray liver w/o 05181 05182 hemodyn 75889 Vein x-ray liver 05182 05183 w/hemodynam 75891 Vein x-ray liver 05182 05183 75893 Venous sampling by catheter 05183 05184 75898 Follow-up angiography 05181 05182 76080 X-ray exam of fistula 05524 05523 76120 Cine/video x-rays 05521 05522 76510 Ophth us b & quant a 05735 05734 76514 Echo exam of eye thickness 05732 05731 76516 Echo exam of eye 05521 05522 76519 Echo exam of eye 05521 05522 76800 Us exam spinal canal 05521 05522 76827 Echo exam of fetal heart 05523 05522 76882 Us lmtd jt/nonvasc xtr strux 05521 05522 76970 Ultrasound exam follow-up 05521 05522

24 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 76977 Us bone density measure 05521 05522 77065 Dx mammo incl cad uni B A 62 N/A 77066 Dx mammo incl cad bi B A 62 N/A 77067 Scr mammo bi incl cad B A 62 N/A 77073 X-rays bone length studies 05521 05522 77084 Magnetic image bone 05524 05523 marrow 77316 Brachytx isodose plan simple 05611 05612 77778 Apply interstit radiat compl Q3 S 80055 Obstetric panel E1 Q4 28 N/A 86079 Phys blood bank serv authrj 05672 05671 86900 Blood typing serologic abo 05733 05734 86976 Rbc serum pretx id dilution 05732 05731 86978 Rbc pretreatment serum 05731 05732 88106 Cytopath fl nongyn filter 05732 05731 88120 Cytp urne 3-5 probes ea spec 05673 05672 88172 Cytp dx eval fna 1st ea site 05673 05672 88300 Surgical path gross 05732 05731 88323 Microslide consultation 05672 05671 88356 Analysis nerve 05672 05671 89255 Prepare embryo for transfer 05672 05671 89264 Identify sperm tissue 05672 05671 90385 Rh ig minidose im N E2 N/A 13 90471 Immunization admin S Q1 90473 Immune admin oral/nasal S Q1 90750 Hzv vacc recombinant im njx E1 M 9 72 90832 Psytx w pt 30 minutes 05822 05823 90868 Tcranial magn stim tx deli 05722 05721 90880 Hypnotherapy 05823 05822 90899 Psychiatric service/therapy 05823 05821 92226 Special eye exam subsequent 05733 05734 92230 Eye exam with photos 05735 05723 92283 Color vision examination 05733 05734 92313 Contact lens fitting 05733 05734 92326 Replacement of contact lens 05733 05734 92537 Caloric vstblr test w/rec 05722 05721 92538 Caloric vstblr test w/rec 05722 05721 92552 Pure tone audiometry air 05733 05734 92564 Sisi hearing test 05732 05731 92941 Prq card revasc mi 1 vsl 05193 00000 J1 C 93229 Remote 30 day ecg tech supp 05733 05721 93291 Ilr device interrogate 05732 05731 93503 Insert/place heart catheter 05181 05182 93505 Biopsy of heart lining 05182 05183 93701 Bioimpedance cv analysis 05735 05734 93886 Intracranial complete study 05523 05522 93981 Penile vascular study 05523 05522 94668 Chest wall manipulation 05733 05734 95004 Percut allergy skin tests 05735 05723 95027 Icut allergy titrate-airborn 05732 05731 95044 Allergy patch tests 05735 05723

25 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 95056 Photosensitivity tests 05733 05734 95115 Immunotherapy one injection S Q1 95117 Immunotherapy injections S Q1 95144 Antigen therapy services S Q1 95145 Antigen therapy services S Q1 95146 Antigen therapy services S Q1 95147 Antigen therapy services S Q1 95148 Antigen therapy services S Q1 95149 Antigen therapy services S Q1 95165 Antigen therapy services S Q1 95170 Antigen therapy services S Q1 95801 Slp stdy unatnd w/anal 05733 05734 95923 Autonomic nrv syst funj test 05733 05734 95933 Blink reflex test 05733 05734 95981 Io anal gast n-stim subsq 05733 05734 96127 Brief emotional/behav assmt 05731 05732 96371 Sc ther infusion reset pump S Q1 96372 Ther/proph/diag inj sc/im S Q1 96377 Applicaton on-body injector 00000 05691 N Q1 96379 Ther/prop/diag inj/inf proc S Q1 96401 Chemo anti-neopl sq/im S Q1 96402 Chemo hormon antineopl S Q1 sq/im 96405 Chemo intralesional up to 7 S Q1 96549 Chemotherapy unspecified S Q1 96922 Laser tx skin >500 sq cm 05051 05052 96932 Rcm celulr subcelulr img skn 05732 05731 99195 Phlebotomy 05733 05734 A9564 P32 chromic phosphate 01676 00000 K E1 N/A 9 A9586 Florbetapir f18 01664 00000 G N C1822 Gen, neuro, hf, rechg bat 01661 00000 H N C2613 Lung bx plug w/del sys 02613 00000 H N C2623 Cath, translumin, drug-coat 02623 00000 H N C2644 Brachytx cesium-131 00000 02644 E2 U 13 N/A chloride C8907 Mri w/o cont, breast, bi 05524 05523 C8933 Mra, w/o&w/dye, spinal 05572 05571 canal C8936 Mra, w/o&w/dye, upper extr 05572 05571 C9248 Inj, clevidipine butyrate 09248 00000 K N C9447 Inj, phenylephrine ketorolac 01663 00000 G N G0106 Colon ca screen;barium 05523 05571 enema G0120 Colon ca scrn; barium enema 05524 05571 G0166 Extrnl counterpulse, per tx 05735 05734 G0397 Alcohol/subs interv >30 min 05823 05822 G0455 Fecal microbiota prep instil 05735 05301 J0120 Tetracyclin injection 01666 00000 K N J0130 Abciximab injection 01605 00000 K N J0215 Alefacept 01633 00000 K E2 N/A 13 J0288 Ampho b cholesteryl sulfate N E2 N/A 13

26 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit J0400 Aripiprazole injection 00000 09064 N K J0470 Dimecaprol injection 00000 09076 N K J0520 Bethanechol chloride inject N E2 N/A 13 J0583 Bivalirudin 03041 00000 K N J0596 Injection, ruconest G K J0695 Inj ceftolozane tazobactam G K J0710 Cephapirin sodium injection E1 E2 9 13 J0875 Injection, dalbavancin G K J0884 Argatroban esrd dialysis 1mg 00000 09065 N K J0888 Epoetin beta non esrd 00000 09077 N K J1110 Inj dihydroergotamine mesylt 00000 09066 N K J1205 Chlorothiazide sodium inj 00747 00000 K N J1324 Enfuvirtide injection 01361 00000 K E2 N/A 13 J1435 Injection estrone per 1 mg E1 E2 9 13 J1436 Etidronate disodium inj N E1 N/A 9 J1452 Intraocular fomivirsen na N E2 N/A 13 J1562 Vivaglobin, inj E1 E2 9 13 J1600 Gold sodium thiomaleate inj N E2 N/A 13 J1655 Tinzaparin sodium injection E2 N 13 N/A J1730 Diazoxide injection 09060 00000 K E2 N/A 13 J1833 Injection, isavuconazonium G K J1945 Lepirudin 01693 00000 K E2 N/A 13 J2260 Inj milrinone lactate / 5 mg 09061 00000 K N J2358 Olanzapine long-acting inj 01331 00000 K N J2407 Injection, oritavancin G K J2460 Oxytetracycline injection N E2 N/A 13 J2502 Inj, pasireotide long acting G K J2510 Penicillin g procaine inj 01836 00000 K N J2547 Injection, peramivir G K J2670 Totazoline hcl injection 01457 00000 K N J2725 Inj protirelin per 250 mcg E1 E2 9 13 J2730 Pralidoxime chloride inj 01855 00000 K N J2860 Injection, siltuximab G K J2910 Aurothioglucose injeciton N E2 N/A 13 J3090 Inj tedizolid phosphate G K J3145 Testosterone undecanoate 00000 09078 N K 1mg J3280 Thiethylperazine maleate inj N E2 N/A 13 J3305 Inj trimetrexate glucoronate N E2 N/A 13 J3320 Spectinomycn di-hcl inj E1 E2 9 13 J3350 Urea injection E2 N 13 N/A J3355 Urofollitropin, 75 iu 01741 00000 K E2 N/A 13 J3365 Urokinase 250,000 iu inj 01838 00000 K E2 N/A 13 J7121 5% dextrose in lac ringers E2 N 13 N/A J7191 Factor viii (porcine) 01464 00000 K E2 N/A 13 J7196 Antithrombin recombinant 01332 00000 K E2 N/A 13 J7309 Methyl aminolevulinate, top 01338 00000 K N J7310 Ganciclovir long act implant 00913 00000 K E2 N/A 13 J7313 Fluocinol acet intravit imp G K J7320 Genvisc 850, inj, 1mg 00000 09079 E2 K 13 N/A J7336 Capsaicin 8% patch 00000 09071 N K

27 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit J7513 Daclizumab, parenteral 01612 00000 K E2 N/A 13 J8510 Oral busulfan 01839 00000 K N J8650 Nabilone oral 01424 00000 K E2 N/A 13 J8655 Netupitant palonosetron oral G K J8700 Temozolomide 01086 00000 K N J9032 Injection, belinostat, 10mg G K J9039 Injection, blinatumomab G K J9151 Daunorubicin citrate inj 00821 00000 K E2 N/A 13 J9160 Denileukin diftitox inj E1 E2 9 13 J9185 Fludarabine phosphate inj 00000 09080 N K J9200 Floxuridine injection 00827 00000 K N J9208 Ifosfamide injection 00831 00000 K N J9212 Interferon alfacon-1 inj E2 N 13 N/A J9213 Interferon alfa-2a inj 01460 00000 K N J9219 Leuprolide acetate implant 01842 00000 K E2 N/A 13 J9263 Oxaliplatin 01738 00000 K N J9271 Inj pembrolizumab G K J9299 Injection, nivolumab G K J9351 Topotecan injection 09062 00000 K N Q2009 Fosphenytoin inj pe 00000 09072 N K Q2026 Radiesse injection N E2 N/A 13 Q2028 Inj, sculptra, 0.5mg N E2 N/A 13 Q4172 Puraply or puraply am 01657 00000 G N Q9950 Inj sulf hexa lipid microsph 09457 00000 G N

HCPCS Edit Changes

The following code(s) were added to the list of male procedures, effective 01-01-18 Hcpcs 55874 C9748

The following code(s) were added to the list of female procedures, effective 01-01-18 Hcpcs 0500T 58575 87624 87625 G0476 J7296

28 Comprehensive APC Complexity Adjusted Code Pair Changes

The following code pairs were added to the comprehensive APC complexity adjusted pairs list, effective 01-01-18 Primary HCPCS Secondary HCPCS 11044 28820 11044 28825 11623 11623 11624 11644 19301 38500 19301 38530 19302 19318 19370 19370 20220 20206 20225 20206 20690 27818 20982 22511 21031 21031 22510 22512 22511 22512 22513 20250 22513 22514 23515 23550 23655 23655 25000 26160 25071 25071 25118 25118 25447 64718 25608 25545 25608 25605 25609 25609 26410 26410 26418 26418 26437 26437 26525 26525 27446 27334 27687 28285 27792 27766 28035 64704 28118 27687 28124 28124 28200 28308 28234 28234 28297 28308 28299 28299 28300 27695 28300 28304 28308 27687 28308 28292 28308 28313 28645 28645

29 Primary HCPCS Secondary HCPCS 28740 20902 28740 27691 28740 28308 28740 28485 28740 38220 28750 28750 28820 28232 28820 28820 28820 28825 28825 28232 28825 28825 29806 29827 29823 29821 29838 29834 29882 29879 29916 29915 30520 30130 30520 30140 30520 30630 31020 30520 31201 31201 31525 31622 31526 31622 31535 43246 31624 31624 31625 31623 31625 31635 31641 31652 31653 31628 31653 31629 31653 31641 32556 32556 33208 93460 33282 93460 37184 37224 37221 37184 37224 37220 37224 37224 37224 93458 37225 37184 37225 37220 37225 37225 37225 37228 37226 37184 37238 37187 37243 37243 38221 32405 38221 50200 38500 11644 38500 56620 38510 11606

30 Primary HCPCS Secondary HCPCS 38510 11623 38510 21016 38510 31536 38510 69110 38525 24071 38525 25071 38525 25078 38525 26951 41874 41874 43220 43201 43238 43251 43249 31622 43257 43252 43262 43242 43270 43237 43270 43242 47000 48102 47534 47536 47538 47538 47555 47536 49406 49180 49505 49505 49505 54520 49507 49505 49507 49507 49507 49585 49507 49587 49520 49505 49520 49520 49520 49585 49520 54520 49521 49521 49525 49505 49525 49585 49560 11406 49560 49505 49560 49507 49560 49520 49560 49560 49560 49561 49560 49587 49561 49505 49561 49561 49587 49505 49653 49329 50385 52005 50432 50432 50432 50435 50432 52005 50432 52310 50433 50432

31 Primary HCPCS Secondary HCPCS 50433 50433 50433 50435 50434 50434 50434 50435 52204 52005 52204 C9738 52214 52287 52214 C9738 52224 52287 52224 C9738 52240 50432 52276 51040 52276 51102 52276 52204 52276 55700 52283 52276 52287 52276 52332 50432 52351 50432 52601 49505 54161 52281 54161 54100 54840 55060 58661 52332 58661 57240 58661 58260 64821 64822 66160 66984 67314 67314 67880 67880 67912 67912 67950 67961 67950 67966 67971 67966 68130 68135 93454 92978 93455 92978 93455 93571 93456 92978 93456 93571 93457 93571 93458 92978 93458 93454 93458 93571 93459 92978 93459 93455 93459 93571 93460 92978 93460 93571 93461 93571 C9600 33208

32 Primary HCPCS Secondary HCPCS C9600 33210

The following code pairs were removed from the comprehensive APC complexity adjusted pairs list, effective 01-01-18 Primary HCPCS Secondary HCPCS 11404 11423 11406 11423 11424 11423 11606 11404 11624 11643 11643 11623 11644 11623 19083 19100 19301 38505 19340 38525 20220 20220 20225 20220 22513 20225 22514 20225 25075 25075 25111 26055 25447 29848 25607 25607 25608 25608 25609 20690 26735 26735 27650 28100 27814 27810 28010 28010 28153 28153 28200 28200 28232 28232 28272 28272 28289 28285 28292 28308 28296 28110 28296 28122 28299 28288 28299 28645 28300 28306 28313 28308 28740 28296 28750 28755 29821 29824 29824 29823 29824 64721 29882 29881 30520 31020 30630 30520 31528 31541

33 Primary HCPCS Secondary HCPCS 31629 31640 31635 31625 31641 31629 32400 32405 32405 20206 32405 47000 32556 32405 33208 C9600 33282 93619 37221 37236 37226 37226 37226 37236 37236 C9600 37238 37241 38220 38220 38500 19101 38500 19301 38500 19304 38500 28820 38505 20206 38525 19101 38530 19301 43191 31526 43201 43226 43238 43249 43249 43249 43254 43249 49180 20206 49180 38505 49180 47000 49653 49650 50200 48102 50949 58661 51040 52204 51102 52310 52214 51040 52214 52224 52275 52005 52287 52214 52287 52224 52356 52648 54161 52005 54840 54840 55700 52281 57265 57267 64555 63650 67900 67917 67911 67917 92920 92974 92920 93456 92941 92928

34 Primary HCPCS Secondary HCPCS 93452 93458 93454 93454 93459 93458 C9600 C9600 C9604 C9604

HCPCS Approval and/or Termination Date Changes

The following code(s) had approval and /or termination date changes HCPCS Old ApprovalDt New ApprovalDt Old TerminationDt New TerminationDt 0421T 0 20170605

Edit Assignments

The following code(s) were added to edit 67, 68, 69 or 83 effective 04-01-17 HCPCS Edit# ActivDate TermDate 0421T 68 20170605

The following code(s) were assigned as blood products, effective 01-01-18 HCPCS P9073

The following code(s) were added to the conditional bilateral list, effective 01-01-18 HCPCS 0485T 20939 31241 31253 31257 31259 31298 32994 34707 34708 34713 34714 34715 34716 36465 36466 36482 36483 38222

The following code(s) were added to the inherently bilateral list, effective 01-01-18 HCPCS 0486T 0494T 38573 58575 77066 77067

The following drug or biological code(s) were added to the list of exclusions for not requiring an OPPS payable procedure for edit 99, effective 01-01-18 HCPCS J7210 J7211

The following drug or biological code(s) were removed from the list of exclusions for not requiring an OPPS payable procedure for edit 99, effective 01-01-18 HCPCS J7191

Device Dependent Procedure Changes

The following code(s) were added to the device dependent procedure list (edit 92), effective 01-01-18 HCPCS 0408T 0409T 0410T 0411T 0414T 0424T 0446T 0449T 22867 22869 27447 28291 28446 36560 43284 47538 47540 54660 66183

36 The following code(s) were removed from the device dependent procedure list (edit 92), effective 01- 01-18 HCPCS 0101T 0253T 21120 21275 21346 23485 24362 24430 25415 25420 25425 25426 25445 26568 27111 27356 27397 27407 27416 27509 27709 27745 27871 28305 28436 28545 33216 37184 37224 41822 43754 44370 47556 58356 61623 64766 64890 64891 64893 64897 75840 75898 93532

37 Device Credit Procedure Changes

The following code(s) were added to the list that may be subject to device credit when the procedure is terminated early, effective 01-01-18 HCPCS Amount 0408T $14,349.73 0409T $9,065.31 0410T $3,022.11 0411T $3,022.11 0414T $9,065.31 0424T $21,532.46 0446T $200.16 0449T $1,480.41 22867 $9,256.42 22869 $9,256.42 27447 $4,150.40 28291 $2,454.49 28446 $2,286.86 36560 $1,046.70 43284 $3,831.13 47538 $2,067.04 47540 $1,918.01 54660 $1,598.41 66183 $1,489.80

The following code(s) were removed from the list that may be subject to device credit when the procedure is terminated early, effective 01-01-18 HCPCS Amount 0101T $1,136.75 0253T $1,487.50 21120 $1,850.66 21275 $2,494.67 21346 $1,783.33 23485 $3,949.74 24362 $4,105.59 24430 $3,916.28 25415 $2,237.44 25420 $2,097.50 25425 $2,751.25 25426 $1,016.54 25445 $2,144.50 26568 $2,655.69 27111 $990.45 27356 $4,895.35 27397 $3,327.71 27407 $2,101.16 27416 $2,322.03 27509 $2,129.36 27709 $4,018.58 27745 $2,136.67

38 HCPCS Amount 27871 $3,872.30 28305 $2,189.93 28436 $2,101.68 28545 $1,072.63 33216 $2,955.97 37184 $1,838.92 37224 $2,746.99 41822 $814.64 43754 $109.39 44370 $1,873.37 47556 $2,097.47 58356 $1,597.13 61623 $3,957.54 61888 $3,585.52 64565 $3,686.06 64766 $1,699.77 64890 $1,727.17 64891 $2,241.59 64893 $1,680.26 64897 $2,494.44 75840 $1,731.26 75898 $285.90 93532 $1,470.33

The following code(s) were added to the list of pass-through device code pairs subject to payment offset, effective 07-01-17 PassThroughDevice DeviceProcedure Amount C2623 36902 $0.00 C2623 36903 $0.00

The following code(s) were removed from the list of pass-through device code pairs subject to payment offset, effective 01-01-18 PassThroughDevice DeviceProcedure Amount C1822 63685 $22,340.91 C2613 32405 $13.23 C2623 37224 $0.00 C2623 37225 $0.00 C2623 37226 $0.00 C2623 37227 $0.00 C2623 36902 $0.00 C2623 36903 $0.00

39 Pass Through Drug or Biological Offset Procedure Changes

The following pass-through radiopharmaceutical codes subject to APC payment offset were removed, effective 01-01-18 HCPCS A9586

The following pass-through skin substitute product codes subject to APC payment offset were removed, effective 01-01-18 HCPCS Q4172

The following pass-through radiological contrast codes subject to APC payment offset were removed, effective 01-01-18 HCPCS Q9950

Deductible/Coinsurance Procedure Code Changes

The following code(s) were added to the Deductible Coinsurance N/A list, effective 01-01-17 HCPCS G0473

The following code(s) were added to the Deductible Coinsurance N/A list, effective 01-01-18 HCPCS 00812 86780 99153 G0500 G0513 G0514

Skin Substitute Low Cost Product Procedure Changes

The following code(s) were added to the skin substitute low cost product list, effective 01-01-18 HCPCS Q4176 Q4178 Q4179 Q4180 Q4181 Q4182

40 The following code(s) were removed from the skin substitute low cost product list, effective 01-01-18 HCPCS Q4162

Non-standard CT Scan Equipment Procedure Changes

The following code(s) were removed from the non-standard (NEMA) CT scan procedure list when reported with modifier CT, effective 01-01-18 HCPCS 75635 76497

Section 603 HCPCS Exclusions

The following code(s) were added to the list of HCPCS excluded from Section 603 payment reduction, effective 01-01-18 HCPCS G6015 G6016

FQHC PPS Procedure Changes

The following influenza and PPV vaccine procedure codes are added for FQHC PPS, effective 01-01-18 HCPCS 90756

The following FQHC PPS non-covered procedure codes are added, effective 01-01-18 HCPCS 99484 99487 99489 99490 99492 99493 99494

The following code(s) were added to the FQHC chronic care procedure list, effective 01-01-16 HCPCS 99490

The following code(s) were added to the FQHC chronic care procedure list, effective 01-01-18 HCPCS G0511 G0512

41 Critical Care Ancillary Procedure Changes

The following code(s) were added to the Critical Care Ancillary procedure list, effective 01-01-18 HCPCS 71045 71046

The following code(s) were removed from the Critical Care Ancillary procedure list, effective 01-01-18 HCPCS 36600 43752 94660

MODIFIERS

Added Modifiers

The following modifier(s) were added to the list of valid modifiers, effective 01-01-18 modif ACTIVATIONDATE 96 0 97 0 FY 0 JG 0 TB 0 X1 0 X2 0 X3 0 X4 0 X5 0 ZC 20170724

Deleted Modifiers

The following modifier(s) were deleted from the list of valid modifiers, effective 01-01-18 modif ACTIVATIONDATE 1P 0 2P 0 3P 0 CP 0 SZ 0