Get Ready for HCPCs: Here’s an Update

The Centers for Medicare and Medicaid Services (CMS) has released a summary of each HCPCS Level II code application decision. The document is twenty-eight pages long and the link can be found in the Resources section.

There are 23 items included in the Second Quarter 2024 Drug and Biological decisions. Twenty new codes have been established. There is one title revision and two code deletions.

It is recommended to review the application results to determine when the code becomes active or inactive.

There is also an analysis of HCPCS codes for products approved by the Food and Drug Administration (FDA) under the 505(b)(2) NDA and BLA Pathways and Products Not Otherwise Classified. The results are eight new codes, one revision, and four deletions as shown below:

The release of the application decisions means that the chargemaster coordinator must review the chargemaster to see if the changes impact the file.

Each of the added items should be discussed with the pharmacy department or chief medical officer (CMO) to determine if there is a plan to add these drugs and biologicals to the formulary. Pharmaceuticals can be difficult because of the translation that is made from the units described in the code description to the usual dosage amount.

The HCPCS codes are updated on a quarterly basis so this process should occur with each release. It is important to avoid unnecessary claim denials due to inactive codes or missed charges because the new codes are not available for reporting.

Resources:

2024-hcpcs-application-summary-quarter-2-2024-drugs-and-biologicals.pdf (cms.gov)