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iv

INTRODUCTION v

GUIDE TO USING THE 2020 HCPCS LEVEL II CODES vi

SYMBOLS AND CONVENTIONS vii

2020 HCPCS UPDATES xiii

ANATOMY ILLUSTRATIONS xv

2020 INDEX 1

2020 TABLE OF DRUGS 45

2020 HCPCS LEVEL II MODIFIERS 101

2020 HCPCS LEVEL II NATIONAL CODES 113

Appendix A—Jurisdiction List for DMEPOS HCPCS Codes 427

Appendix B—Chapter 1, General Correct Coding Policies for National Correct Coding Initiative Policy Manual for Medicare Services 433

Figure Credits 448

Updates will be posted on codingupdates.com when available.

Check codingupdates.com for Practitioner and Facility Medically Unlikely Edits (MUEs) and Column 1 and Column 2 Edits.

Check the Centers for Medicare & Medicaid Services (www.cms.gov/Manuals/IOM/list.asp) website and codingupdates.com for full and select IOMs.

Notice: 2020 DMEPOS updates were unavailable at the time of printing. Check codingupdates.com for updates and DMEPOS Modifiers in January.

CONTENTS

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A4261 Cervical cap for contraceptive use Indicates for female only.

A4267 Contraceptive supply, condom, male, each Indicates for male only.

] A4233 Replacement battery, alkaline (otherthan J cell), for use with medically necessary home blood glucose monitor owned by patient, each

If “incident to” physician service, do not bill; otherwise bill DME MAC

On DMEPOS Fee Schedule.

b B9000 Enteral nutrition infusion pump ‑ with‑out alarm Y

Pump will be denied as not medically necessary if medical necessity of pump is not documented

IOM: 100-02, 15, 120; 100-03, 3, 180.2; 100-04, 20, 100.2.2

PEN: On Fee Schedule On the Parenteral and Enteral Nutrition Items or Services (PEN) with modifier(s) from current PEN Fee Schedule.

viii Symbols and Conventions

Codes shown are for illustration purposes only and may not be current codes.

E2210 Wheelchair accessory, bearings, any type, replacement only, each DMEPOS symbol identifies

durable medical equipment, prosthetics, orthotics, and supplies that may be eligible for payment from CMS.

Indicates a reinstated code. D2970 Temporary crown (fractured tooth)

Indicates new information or a new code.

�A4614 Peak expiratory flow rate meter, hand‑held

Indicates a revisionwithin the line or code.

J0270 Injection alprostadil, per 1.25 mcg

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A2-Z3 ASC Payment Indicators

Final ASC Payment Indicators for CY 2020

Payment Indicator Payment Indicator DefinitionA2 Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.

B5 Alternative code may be available; no payment made.

D5 Deleted/discontinued code; no payment made.

F4 Corneal tissue acquisition, hepatitis B vaccine; paid at reasonable cost.

G2 Non-office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative pay-ment weight.

H2 Brachytherapy source paid separately when provided integral to a surgical procedure on ASC list; pay-ment OPPS rate.

J7 OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced.

J8 Device-intensive procedure; paid at adjusted rate.

K2 Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; pay-ment based on OPPS rate.

K7 Unclassified drugs and biologicals; payment contractor-priced.

L1 Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made.

L6 New Technology Intraocular Lens (NTIOL); special payment.

N1 Packaged service/item; no separate payment made.

P2 Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight.

P3 Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs.

R2 Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight.

Z2 Radiology or diagnostic service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight.

Z3 Radiology or diagnostic service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS nonfacility PE RVUs.

CMS-1678-FC, Final Changes to the ASC Payment System and CY 2020 Payment Rates, http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices.html.

x 2020 HCPCS A2-Z3 ASC Payment Indicators

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DRUGS OTHER THAN CHEMOTHERAPY DRUGS

315

DRU

GS O

THER TH

AN

CHEM

OTH

ERAPY D

RUG

S J3420 – J7040

MIPS MIPS Quantity Physician Quantity Hospital Female only

Male only Age DMEPOS A2-Z3 ASC Payment Indicator A-Y ASC Status Indicator Coding Clinic

J3490 Unclassified drugs N1 N

Bill on paper. Bill one unit. Identify drug and total dosage in “Remarks” field.

Other: Acthib, Aminocaproic Acid, Baciim, Bacitracin, Benzocaine, Bumetanide, Bupivacaine, Cefotetan, Ciprofloxacin, Cleocin Phosphate, Clindamycin, Cortisone Acetate Micronized, Definity, Diprivan, Doxy, Engerix-B, Ethanolamine, Famotidine, Ganirelix, Gonal-F, Hyaluronic Acid, Marcaine, Metronidazole, Nafcillin, Naltrexone, Ovidrel, Pegasys, Peg-Intron, Penicillin G Sodium, Propofol, Protonix, Recombivax, Rifadin, Rifampin, Sensorcaine-MPF, Smz-TMP, Sufentanil Citrate, Testopel Pellets, Testosterone, Treanda, Valcyte, Veritas Collagen Matrix

IOM: 100-02, 15, 50

Coding Clinic: 2017, Q1, P1-3, P8; 2014, Q2, P6; 2013, Q2, P3-4

� J3520 Edetate disodium, per150 mg E1

Other: Chealamide, Disotate, Endrate ethylenediamine-tetra-acetic

IOM: 100-03, 1, 20.21; 100-03, 1, 20.22

J3530 Nasal vaccine inhalation N1 N

IOM: 100-02, 15, 50

� J3535 Drug administered through a metereddose inhaler E1

Other: Ipratropium bromide

IOM: 100-02, 15, 50

� J3570 Laetrile, amygdalin,vitamin B-17 E1

IOM: 100-03, 1, 30.7

J3590 Unclassified biologics N1 N

Bill on paper. Bill one unit. Identify drug and total dosage in “Remarks” field.

Coding Clinic: 2017, Q1, P1-3; 2016, Q4, P10

J3591 Unclassified drug or biological used for ESRD on dialysis B

J7030 Infusion, normal saline solution, 1000 cc N1 N

Other: Sodium Chloride

IOM: 100-02, 15, 50

J7040 Infusion, normal saline solution, sterile (500 ml = 1 unit) N1 N

Other: Sodium Chloride

IOM: 100-02, 15, 50

J3420 Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg N1 N

Medicare carriers may have local coverage decisions regarding vitamin B12 injections that provide reimbursement only for patients with certain types of anemia and other conditions.

Other: Berubigen, Betalin 12, Cobex, Redisol, Rubramin PC, Sytobex

IOM: 100-02, 15, 50; 100-03, 2, 150.6

J3430 Injection, phytonadione (vitamin K), per 1 mg N1 N

Other: AquaMephyton, Konakion, Menadione, Synkavite, Vitamin K1

IOM: 100-02, 15, 50

J3465 Injection, voriconazole, 10 mg K2 K

Other: VFEND

IOM: 100-02, 15, 50

J3470 Injection, hyaluronidase, up to 150 units N1 N

Other: Amphadase, Wydase

IOM: 100-02, 15, 50

J3471 Injection, hyaluronidase, ovine, preservative free, per 1 USP unit (up to 999 USP units) N1 N

Other: Vitrase

J3472 Injection, hyaluronidase, ovine, preservative free, per 1000 USP units N1 N

J3473 Injection, hyaluronidase, recombinant, 1 USP unit N1 N

Other: Hylenex

IOM: 100-02, 15, 50

J3475 Injection, magnesium sulfate, per 500 mg N1 N

IOM: 100-02, 15, 50

J3480 Injection, potassium chloride, per 2 meq N1 N

IOM: 100-02, 15, 50

J3485 Injection, zidovudine, 10 mg N1 N

Other: Retrovir

IOM: 100-02, 15, 50

J3486 Injection, ziprasidone mesylate, 10 mg N1 N

Other: Geodon

J3489 Injection, zoledronic acid, 1 mg N1 N

Other: Reclast, Zometra

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TEMPORARY NATIONAL CODES ESTABLISHED BY PRIVATE PAYERS

403

TEMPO

RARY N

ATION

AL CO

DES ESTA

BLISH

ED B

Y PRIVATE PAYERS S0810 – S2083

MIPS MIPS Quantity Physician Quantity Hospital Female only

Male only Age DMEPOS A2-Z3 ASC Payment Indicator A-Y ASC Status Indicator Coding Clinic

� S2054 Transplantation of multivisceral organs

� S2055 Harvesting of donor multivisceralorgans, with preparation and maintenance of allografts; from cadaver donor

� S2060 Lobar lung transplantation

� S2061 Donor lobectomy (lung) fortransplantation, living donor

� S2065 Simultaneous pancreas kidneytransplantation

� S2066 Breast reconstruction with glutealartery perforator (GAP) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral

� S2067 Breast reconstruction of a single breastwith “stacked” deep inferior epigastric perforator (DIEP) flap(s) and/or gluteal artery perforator (GAP) flap(s), including harvesting of the flap(s), microvascular transfer, closure of donor site(s) and shaping the flap into a breast, unilateral

� S2068 Breast reconstruction with deepinferior epigastric perforator (DIEP) flap, or superficial inferior epigastric artery (SIEA) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral

� S2070 Cystourethroscopy, with ureteroscopyand/or pyeloscopy; with endoscopic laser treatment of ureteral calculi (includes ureteral catheterization)

� S2079 Laparoscopic esophagomyotomy(Heller type)

� S2080 Laser-assisted uvulopalatoplasty(LAUP)

Figure 48 Phototherapeutic keratectomy (PRK).

� S0810 Photorefractive keratectomy (PRK)

� S0812 Phototherapeutic keratectomy (PTK)

� S1001 Deluxe item, patient aware (list inaddition to code for basic item)

� S1002 Customized item (list in addition tocode for basic item)

� S1015 IV tubing extension set

� S1016 Non-PVC (polyvinyl chloride)intravenous administration set, for use with drugs that are not stable in PVC (e.g., paclitaxel)

� S1030 Continuous noninvasive glucosemonitoring device, purchase (for physician interpretation of data, use CPT code)

� S1031 Continuous noninvasive glucosemonitoring device, rental, including sensor, sensor replacement, and download to monitor (for physician interpretation of data, use CPT code)

� S1034 Artificial pancreas device system (e.g.,low glucose suspend (LGS) feature) including continuous glucose monitor, blood glucose device, insulin pump and computer algorithm that communicates with all of the devices

� S1035 Sensor; invasive (e.g., subcutaneous),disposable, for use with artificial pancreas device system

� S1036 Transmitter; external, for use withartificial pancreas device system

� S1037 Receiver (monitor); external, for usewith artificial pancreas device system

� S1040 Cranial remolding orthosis, pediatric,rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)

S1090 Mometasone furoate sinus implant, 370 micrograms

� S2053 Transplantation of small intestine andliver allografts

Figure 49 Gastric band.

� S2083 Adjustment of gastric band diametervia subcutaneous port by injection or aspiration of salineSample page

2020 HCPCS LEVEL II NATIONAL CODES

406

S386

5 –

S500

1 TE

MPO

RARY

NAT

ION

AL

COD

ES E

STA

BLI

SHED

BY

PRIV

ATE

PAYE

RS

� New Revised Reinstated deleted Deleted � Not covered or valid by Medicare

Special coverage instructions Carrier discretion Bill Part B MAC Bill DME MAC

� S4026 Procurement of donor sperm fromsperm bank

� S4027 Storage of previously frozen embryos

� S4028 Microsurgical epididymal spermaspiration (MESA)

� S4030 Sperm procurement andcryopreservation services; initial visit

� S4031 Sperm procurement andcryopreservation services; subsequent visit

� S4035 Stimulated intrauterine insemination(IUI), case rate

� S4037 Cryopreserved embryo transfer, caserate

� S4040 Monitoring and storage ofcryopreserved embryos, per 30 days

� S4042 Management of ovulation induction(interpretation of diagnostic tests and studies, non-face-to-face medical management of the patient), per cycle

� S4981 Insertion of levonorgestrel-releasingintrauterine system

� S3865 Comprehensive gene sequence analysisfor hypertrophic cardiomyopathy

� S3866 Genetic analysis for a specific genemutation for hypertrophic cardiomyopathy (HCM) in an individual with a known HCM mutation in the family

� S3870 Comparative genomic hybridization(CGH) microarray testing for developmental delay, autism spectrum disorder and/or intellectual disability

Other Tests

� S3900 Surface electromyography (EMG)

� S3902 Ballistrocardiogram

� S3904 Masters two step

Bill on paper. Requires a report.

Obstetric and Fertility Services

� S4005 Interim labor facility global (laboroccurring but not resulting in delivery)

� S4011 In vitro fertilization; including but notlimited to identification and incubation of mature oocytes, fertilization with sperm, incubation of embryo(s), and subsequent visualization for determination of development

� S4013 Complete cycle, gamete intrafallopiantransfer (GIFT), case rate

� S4014 Complete cycle, zygote intrafallopiantransfer (ZIFT), case rate

� S4015 Complete in vitro fertilization cycle, nototherwise specified, case rate

� S4016 Frozen in vitro fertilization cycle, caserate

� S4017 Incomplete cycle, treatment cancelledprior to stimulation, case rate

� S4018 Frozen embryo transfer procedurecancelled before transfer, case rate

� S4020 In vitro fertilization procedurecancelled before aspiration, case rate

� S4021 In vitro fertilization procedurecancelled after aspiration, case rate

� S4022 Assisted oocyte fertilization, case rate

� S4023 Donor egg cycle, incomplete, caserate

� S4025 Donor services for in vitro fertilization(sperm or embryo), case rate

Figure 50 IUD.

� S4989 Contraceptive intrauterine device (e.g.,Progestasert IUD), including implants and supplies

Therapeutic Substances and Medications

� S4990 Nicotine patches, legend

� S4991 Nicotine patches, non-legend

� S4993 Contraceptive pills for birth control

Only billed by Family Planning Clinics

� S4995 Smoking cessation gum

� S5000 Prescription drug, generic

� S5001 Prescription drug, brand nameSample page

2020 HCPCS: LEVEL II NATIONAL CODESA

PPEN

DIX

A

430

HCPCS DESCRIPTION JURISDICTIONE0782 - E0783 Infusion Pumps,

ImplantablePart B MAC

E0784 Infusion Pumps, Insulin DME MAC

E0785 - E0786 Implantable Infusion Pump Catheter

Part B MAC

E0791 Parenteral Infusion Pump

DME MAC

E0830 Ambulatory Traction Device

DME MAC

E0840 - E0900 Traction Equipment DME MAC

E0910 - E0930 Trapeze/Fracture Frame DME MAC

E0935 - E0936 Passive Motion Exercise Device

DME MAC

E0940 Trapeze Equipment DME MAC

E0941 Traction Equipment DME MAC

E0942 - E0945 Orthopedic Devices DME MAC

E0946 - E0948 Fracture Frame DME MAC

E0950 - E1298 Wheelchairs DME MAC

E1300 - E1310 Whirlpool Equipment DME MAC

E1352 - E1392 Additional Oxygen Related Equipment

DME MAC

E1399 Miscellaneous DME Part B MAC if implanted DME. If other, DME MAC.

E1405 - E1406 Additional Oxygen Equipment

DME MAC

E1500 - E1699 Artificial Kidney Machines and Accessories

DME MAC (not separately payable)

E1700 - E1702 TMJ Device and Supplies

DME MAC

E1800 - E1841 Dynamic Flexion Devices

DME MAC

E1902 Communication Board DME MAC

E2000 Gastric Suction Pump DME MAC

E2100 - E2101 Blood Glucose Monitors with Special Features

DME MAC

E2120 Pulse Generator for Tympanic Treatment of Inner Ear

DME MAC

E2201 - E2397 Wheelchair Accessories DME MAC

E2402 Negative Pressure Wound Therapy Pump

DME MAC

E2500 - E2599 Speech Generating Device

DME MAC

E2601 - E2633 Wheelchair Cushions and Accessories

DME MAC

E8000 - E8002 Gait Trainers DME MAC

G0008 - G0067 Misc. Professional Services

Part B MAC

G0068 - G0070 Infusion Drug Professional Services

DME MAC

G0071 - G0329 Misc. Professional Services

Part B MAC

HCPCS DESCRIPTION JURISDICTIONG0333 Dispensing Fee DME MAC

G0337 - G0343 Misc. Professional Services

Part B MAC

G0372 Misc. Professional Services

Part B MAC

G0378 - G0490G0491-G9987

Misc. Professional Services

Part B MAC

J0120 - J1094 Injection Part B MAC if incident to a physician’s service or used in an implanted infusion pump. If other, DME MAC.

J1095 - J9591 Ophthalmic Drug Part B MAC

J1100 - J2786 Injection Part B MAC if incident to a physician’s service or used in an implanted infusion pump. If other, DME MAC.

J2787 Ophthalmic Drug Part B MAC

J2788 - J3570 Injection Part B MAC if incident to a physician’s service or used in an implanted infusion pump. If other, DME MAC.

J3590 - J9591 Unclassified Biologicals Part B MAC

J7030 - J7131 Miscellaneous Drugs and Solutions

Part B MAC if incident to a physician’s service or used in an implanted infusion pump. If other, DME MAC.

J7170 - J7179 Clotting Factors Part B MAC

J7180 - J7195 Antihemophilic Factor Part B MAC

J7196 - J7197 Antithrombin III Part B MAC

J7198 Anti-inhibitor; per I.U. Part B MAC

J7199 - J7211 Other Hemophilia Clotting Factors

Part B MAC

J7296 - J7307 Contraceptives Part B MAC

J7308 - J7309 Aminolevulinic Acid HCL Part B MAC

J7310 Ganciclovir, Long-Acting Implant

Part B MAC

J7311 - J7316 Ophthalmic Drugs Part B MAC

J7318 - J7329 Hyaluronan Part B MAC

J7330 Autologous Cultured Chondrocytes, Implant

Part B MAC

J7336 Capsaicin Part B MAC

J7340 Carbidopa/Levodopa Part B MAC if incident to a physician’s service or used in an implanted infusion pump. If other, DME MAC.

J7342 - J7345 Ciprofloxacin otic & Topical Aminolevulinic Acid

Part B MAC

J7500 - J7599 Immunosuppressive Drugs

Part B MAC if incident to a physician’s service or used in an implanted infusion pump. If other, DME MAC.

J7604 - J7699 Inhalation Solutions Part B MAC if incident to a physician’s service. If other, DME MAC.

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