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Overview

OVERVIEW

The Centers for Medicare and Medicaid Services have partnered with the Agency for Healthcare Research and Quality (AHRQ) to commission a review of Negative Pressure Wound Therapy (NPWT) devices. The purpose of this review is to provide information to the Centers for Medicare & Medicaid Services (CMS) for consideration in Healthcare Common Procedure Coding System (HCPCS) coding decisions. Section 154(c) (3) of the Medicare Improvements for Patient and Providers Act of 2008 (MIPPA) calls for the Secretary of Health and Human Services to perform an evaluation of the HCPCS codes for NPWT devices.

The HCPCS Level II coding system is a comprehensive, standardized system that classifies similar products that are medical in nature into categories for the purpose of efficient claims processing. Products are classified based on similarities in function and whether the products exhibit significant therapeutic distinctions from other products. This review will facilitate CMS' evaluation of HCPCS coding for NPWT by providing CMS with relevant studies and information for use in consideration of coding changes, as required by the MIPPA legislation. CMS will use this review in its assessment of whether existing HCPCS codes adequately represent the technology and comparative benefits of NPWT devices.

This review is one of several that are being conducted for the AHRQ Technology Assessment Program. It will include a review of all available literature on the topic and a solicitation from all interested stakeholders including health care professionals, scientific researchers, wound care organizations, biotech industry, and the patient wound care community for studies and other compelling clinical evidence regarding clinical outcomes associated with NPWT devices. We are particularly interested in those well-conducted clinical trials that describe the comparative benefits of these devices.

The solicitation for studies and evidence was made available to industry stakeholders on December 30, 2008, and requested stakeholders provide this information to AHRQ by February 06, 2009. Stakeholders who would like to provide information about studies or other compelling evidence related to comparative benefits and outcomes of NPWT devices should refer to:
http://www.ahrq.gov/clinic/ta/npwtrequest.htm.

 

 

The Centers for Medicare and Medicaid Services is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set. These changes have been posted to the HCPCS website at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp . Changes are effective on the date indicated on the update.

The text at item #11 in the 2009 Alpha-Numeric HCPCS Coding Recommendation Format has been revised to correct errors in the dates presented in this section. View the document titled "Application Form & Instructions – Updated December 2008" in the Downloads section.

The Centers for Medicare and Medicaid Services has reposted the recent scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set to incorporate new changes. The revised update has been posted to the HCPCS website at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp.

The re-posted version includes changes to Current Dental Terminology (CDT) codes contributed by the American Dental Association (ADA) with their scheduled 2008 Update.

In addition, the following changes have been made:

E0764 - Language revised

E0770 - Coverage Indicator changed

Q4114 - Language revised

Please refer to the re-posted Annual Update for specific details.


The Centers for Medicare and Medicaid Services is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set.  These changes have been posted to the HCPCS website at http://www.cms.hhs.gov/medhcpcsgeninfo.  All changes are effective January 1, 2009, unless otherwise indicated in the effective date column.

Notice regarding CMS' HCPCS Coding Decision for Skin Substitute Products:

The 2009 HCPCS Annual Update includes a new code series, Q4100 – Q4114, effective January 1, 2009, to identify skin substitute products.  Codes J7340, J7341, J7342, J7343, J7344, J7346, J7347, J7348, J7349 and C9357 are discontinued effective 12/31/2008.    

Please refer to the 2009 HCPCS Annual Update, posted on CMS' HCPCS Website at:  http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS  for specific code language.

The coding decision was made based on programmatic reasons and to facilitate accurate coding of these products.  Medicare Part B is not changing the way the payment amounts are determined for the products in the new codes.  To the extent that single source drugs or biologicals were within the same billing and payment code as of October 1, 2003, Medicare Part B will continue to treat them as multiple source drugs for payment purposes as required by Section 1847A(c)(6)(C)(ii).


HCPCS Background Information

Each year, in the United States, health care insurers process over 5 billion claims for payment. For Medicare and other health insurance programs to ensure that these claims are processed in an orderly and consistent manner, standardized coding systems are essential. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA. Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.

In October of 2003, the Secretary of HHS delegated authority under the HIPAA legislation to CMS to maintain and distribute HCPCS Level II Codes.  As stated in 42 CFR Sec. 414.40 (a) CMS establishes uniform national definitions of services, codes to represent services, and payment modifiers to the codes. Within CMS there is a CMS HCPCS Workgroup which is an internal workgroup comprised of representatives of the major components of CMS, as well as other consultants from pertinent Federal agencies.   Prior to December 31, 2003, Level III HCPCS were developed and used by Medicaid State agencies, Medicare contractors, and private insurers in their specific programs or local areas of jurisdiction. For purposes of Medicare, level III codes were also referred to as local codes. Local codes were established when an insurer preferred that suppliers use a local code to identify a service, for which there is no level I or level II code, rather than use a "miscellaneous or not otherwise classified code." The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required CMS to adopt standards for coding systems that are used for reporting health care transactions. We published, in the Federal Register on August 17, 2000 (65 FR 50312), regulations to implement this part of the HIPAA legislation. These regulations provided for the elimination of level III local codes by October 2002, at which time, the level I and level II code sets could be used. The elimination of local codes was postponed, as a result of section 532(a) of BIPA, which continued the use of local codes through December 31, 2003.

Downloads
5/18/07 - Update to Information Regarding Medicare Payment and Coding for Drugs and Biologics [PDF, 21KB]

4/25/07 -Update to Information Regarding Medicare Payment and Coding for Drugs & Biologics [PDF, 22KB]

New Information Regarding Medicare Payment and Coding for Drugs and Biologics [PDF, 11KB]

Application Form & Instructions (PDF 46KB) - Updated December 2008

HCPCS Decision Tree & Definitions [PDF, 158KB]

HCPCS Process Revamped [PDF, 56KB]

HCPCS Coding Report: Executive Summary of Stakeholder Survey [PDF, 100KB]

Pilot Medicaid HCPCS Code Modification Request Guidelines [PDF, 25KB]

Place of Service Codes for Professional Claims [PDF, 67KB]
Related Links Inside CMS
Alpha-Numeric HCPCS List

Council on Technology and Innovation

HCPCS Release Code Sets

Alpha-Numeric HCPCS Quarterly Update

HCPCS Annual Update

HCPCS Codes for State Medicaid
Related Links Outside CMSExternal Linking Policy
Negative Pressure Wound Therapy

Pricing, Data Analysis and Coding (PDAC)

 

Page Last Modified: 01/14/2009 8:55:52 AM
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