The following list identifies changes to level II Healthcare Common Procedure Coding System (HCPCS) codes for 2012.
Added Codes/Added Modifiers: New codes and modifiers are effective for dates of service on or after January 1, 2012.
Discontinued Codes/Deleted Modifiers: Codes or modifiers that are discontinued/deleted will continue to be valid for claims with dates of service on or before December 31, 2011, regardless of the date of claim submission. If there is a direct crosswalk for a discontinued/deleted code or modifier, it is listed in the table. The crosswalked codes are also “added” codes effective for dates of service on or after January 1, 2012.
There is no grace period that would allow submission of the discontinued code for dates of service in 2012.
Narrative Changes/Revised Modifiers: A description change for an existing code or modifier is effective for dates of service on or after January 1, 2012.
The appearance of a code in this list does not necessarily indicate coverage.
Ankle-Foot/Knee-Ankle-Foot Orthosis
Narrative Changes
| Code |
Old Narrative |
New Narrative |
| L2005 |
KNEE ANKLE FOOT ORTHOSIS, ANY MATERIAL, SINGLE OR DOUBLE UPRIGHT, STANCE CONTROL, AUTOMATIC LOCK AND SWING PHASE RELEASE, MECHANICAL ACTIVATION, INCLUDES ANKLE JOINT, ANY TYPE, CUSTOM FABRICATED |
KNEE ANKLE FOOT ORTHOSIS, ANY MATERIAL, SINGLE OR DOUBLE UPRIGHT, STANCE CONTROL, AUTOMATIC LOCK AND SWING PHASE RELEASE, ANY TYPE ACTIVATION, INCLUDES ANKLE JOINT, ANY TYPE, CUSTOM FABRICATED |
Immunosuppressive Drugs
Added Code
| Code |
Narrative |
| J8561 |
EVEROLIMUS, ORAL, 0.25 MG |
Intravenous Immune globulin
Added Code
| Code |
Narrative |
| J1557 |
INJECTION, IMMUNE GLOBULIN, (GAMMAPLEX), INTRAVENOUS, NON- LYOPHILIZED (E.G. LIQUID), 500 MG |
Narrative Changes
| Code |
Old Narrative |
New Narrative |
| J1561 |
INJECTION, IMMUNE GLOBULIN, (GAMUNEX), INTRAVENOUS, NON- LYOPHILIZED (E.G.LIQUID), 500 MG |
INJECTION, IMMUNE GLOBULIN, (GAMUNEX/GAMUNEX-C/GAMMAKED), NON- LYOPHILIZED (E.G. LIQUID), 500 MG |
Lower Limb Prostheses
Added Code
| Code |
Narrative |
| L5312 |
KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, SINGLE AXIS KNEE, PYLON, SACH FOOT, ENDOSKELETAL SYSTEM |
Discontinued Code
| Code |
Narrative |
Crosswalk to Code |
| L5311 |
KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, EXTERNAL KNEE JOINTS, SHIN, SACH FOOT, ENDOSKELETAL SYSTEM |
L5312 |
Miscellaneous
Added Code
| Code |
Narrative |
| A9272 |
MECHANICAL WOUND SUCTION, DISPOSABLE, INCLUDES DRESSING, ALL ACCESSORIES AND COMPONENTS, EACH |
| L6715 |
TERMINAL DEVICE, MULTIPLE ARTICULATING DIGIT, INCLUDES MOTOR(S), INITIAL ISSUE OR REPLACEMENT |
| L6880 |
ELECTRIC HAND, SWITCH OR MYOLELECTRIC CONTROLLED, INDEPENDENTLY ARTICULATINGDIGITS, ANY GRASP PATTERN OR COMBINATION OF GRASP PATTERNS, INCLUDES MOTOR(S) |
Narrative Changes
| Code |
Old Narrative |
New Narrative |
| E0638 |
STANDING FRAME SYSTEM, ONE POSITION (E.G. UPRIGHT, SUPINE OR PRONE STANDER), ANY SIZE INCLUDING PEDIATRIC, WITH OR WITHOUT WHEELS |
STANDING FRAME/TABLE SYSTEM, ONE POSITION (E.G. UPRIGHT, SUPINE OR PRONE STANDER), ANY SIZE INCLUDING PEDIATRIC, WITH OR WITHOUT WHEELS |
| E0641 |
STANDING FRAME SYSTEM, MULTI- POSITION (E.G. THREE-WAY STANDER), ANY SIZE INCLUDING PEDIATRIC, WITH OR WITHOUT WHEELS |
STANDING FRAME/TABLE SYSTEM, MULTI- POSITION (E.G. THREE-WAY STANDER), ANY SIZE INCLUDING PEDIATRIC, WITH OR WITHOUT WHEELS |
| E0642 |
STANDING FRAME SYSTEM, MOBILE (DYNAMIC STANDER), ANY SIZE INCLUDING PEDIATRIC |
STANDING FRAME/TABLE SYSTEM, MOBILE (DYNAMIC STANDER), ANY SIZE INCLUDING PEDIATRIC |
| E0691 |
ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE PROTECTION; TREATMENT AREA 2 SQUARE FEET OR LESS |
ULTRAVIOLET LIGHT THERAPY SYSTEM, INCLUDES BULBS/LAMPS, TIMER AND EYE PROTECTION; TREATMENT AREA 2 SQUARE FEET OR LESS |
| L6000 |
PARTIAL HAND, ROBIN-AIDS, THUMB REMAINING (OR EQUAL) |
PARTIAL HAND, THUMB REMAINING |
| L0610 |
PARTIAL HAND, ROBIN-AIDS, LITTLE AND/OR RING FINGER REMAINING (OR EQUAL) |
PARTIAL HAND, LITTLE AND/OR RING FINGER REMAINING |
| L0620 |
PARTIAL HAND, ROBIN-AIDS, NO FINGER REMAINING (OR EQUAL) |
PARTIAL HAND, NO FINGER REMAINING |
| L7368 |
LITHIUM ION BATTERY CHARGER |
LITHIUM ION BATTERY CHARGER, REPLACEMENT ONLY |
Discontinued Code
| Code |
Narrative |
Crosswalk to Code |
| L1500 |
THORACIC-HIP-KNEE-ANKLE ORTHOSIS (THKAO), MOBILITY FRAME (NEWINGTON, PARAPODIUM TYPES) |
NONE |
| L1510 |
THKAO, STANDING FRAME, WITH OR WITHOUT TRAY AND ACCESSORIES |
NONE |
| L1520 |
THKAO, SWIVEL WALKER |
NONE |
| L4380 |
PNEUMATIC KNEE SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
NONE |
| L7266 |
SERVO CONTROL, STEEPER OR EQUAL |
NONE |
| L7272 |
ANALOGUE CONTROL, UNB OR EQUAL |
NONE |
| L7274 |
PROPORTIONAL CONTROL, 6-12 VOLT, LIBERTY, UTAH OR EQUAL |
NONE |
| L7500 |
REPAIR OF PROSTHETIC DEVICE, HOURLY RATE (EXCLUDES V5335 REPAIR OF ORAL OR LARYNGEAL PROSTHESIS OR ARTIFICIAL LARYNX) |
NONE |
Oral Antiemetic Drugs
Added Code
| Code |
Narrative |
| Q0162 |
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN |
Discontinued Code
| Code |
Narrative |
Crosswalk to Code |
| Q0179 |
ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI- EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN |
Q0162 |
Ostomy Supplies
Added Code
| Code |
Narrative |
| A5056 |
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FILTER, (1PIECE), EACH |
| A5057 |
OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT IN CONVEXITY, WITH FILTER, (1 PIECE), EACH |
Power Mobility Devices
Added Code
| Code |
Narrative |
| E2358 |
POWER WHEELCHAIR ACCESSORY, GROUP 34 NON-SEALED LEAD ACID BATTERY, EACH |
| E2359 |
POWER WHEELCHAIR ACCESSORY, GROUP 34 SEALED LEAD ACID BATTERY, EACH (E.G. GEL CELL, ABSORBED GLASSMAT) |
Wheelchair Options/Accessories
Added Code
| Code |
Narrative |
| E0988 |
MANUAL WHEELCHAIR ACCESSORY, LEVER-ACTIVATED, WHEEL DRIVE, PAIR |
| E2626 |
WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, ADJUSTABLE |
| E2627 |
WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, ADJUSTABLE RANCHO TYPE |
| E2628 |
WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, RECLINING |
| E2629 |
WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, FRICTION ARM SUPPORT (FRICTION DAMPENING TO PROXIMAL AND DISTAL JOINTS) |
| E2630 |
WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT, MONOSUSPENSION ARMAND HAND SUPPORT, OVERHEAD ELBOW FOREARM HAND SLING SUPPORT, YOKE TYPE SUSPENSION SUPPORT |
| E2631 |
WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, ELEVATING PROXIMAL ARM |
| E2632 |
WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, OFFSET OR LATERAL ROCKER ARM WITH ELASTIC BALANCE CONTROL |
| E2633 |
WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, SUPINATOR |
Discontinued Code
| Code |
Narrative |
Crosswalk to Code |
| L3964 |
SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, ADJUSTABLE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
E2626 |
| L3965 |
SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, ADJUSTABLE RANCHO TYPE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
E2627 |
| L3966 |
SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, RECLINING, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
E2628 |
| L3968 |
SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, FRICTION ARM SUPPORT (FRICTION DAMPENING TO PROXIMAL AND DISTAL JOINTS), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
E2629 |
| L3969 |
SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT, MONOSUSPENSION ARM AND HAND SUPPORT, OVERHEAD ELBOW FOREARM HAND SLING SUPPORT, YOKE TYPE SUSPENSION SUPPORT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
E2630 |
| L3970 |
SEO, ADDITION TO MOBILE ARM SUPPORT, ELEVATING PROXIMAL ARM |
E2631 |
| L3972 |
SEO, ADDITION TO MOBILE ARM SUPPORT, OFFSET OR LATERAL ROCKER ARM WITH ELASTIC BALANCE CONTROL |
E2632 |
| L3974 |
SEO, ADDITION TO MOBILE ARM SUPPORT, SUPINATOR |
E2633 |
Revision History
| Date |
Update |
| 12/02/2011 |
Published on PDAC website |