2012 HCPCS II Now Available, More Than 430 Changes

16 Nov

The Centers for Medicare & Medicaid Services (CMS) recently released the HCPCS Level II codes that go into effect January 1, 2012. Among the changes are 285 code additions (plus one new modifier), 48 revisions, and 75 deletions. Another 18 codes were added and eight deleted throughout 2011.

The policy requires hospitals to combine the charges and appropriate codes for any outpatient diagnostic and “related” non-diagnostic services, not including ambulance and maintenance renal dialysis, provided within the three-day period immediately preceding an inpatient admission.

Many C and Q codes have been deleted and replaced by new J codes, including C9272 being replaced by J0897 Injection, denosumab, 1 mg; Q2040 replaced by J0588 Injection, incobotulinumtoxin A, 1 unit; and Q2042 replaced by J1725 Injection, hydroxyprogesterone caproate, 1 mg.

There have been a few C codes added for 2012, including C9287 for the lymphoma drug brentuximab vedotin and C9366 for the membrane/skin allograft EpiFix®. Similarly, there are fewer than a dozen new drug/supply Q codes for 2012. Among them are Q0162 for the anti-nausea drug ondansetron, Q2043 for sipuleucel-T, a therapeutic vaccine for prostate cancer, and nine new codes (Q4122-Q4130) for skin substitutes such as Dermacell®, Alloskin™ RT, and Talymed™.

  • A series of new E codes (E0988, E2358-E2359, and E2626-E2633) describe various accessories (e.g., batteries, arm supports) for manual and power wheelchairs.


  • Four new K codes (K0743-K0746) have been added for home suction pumps and supplies for wound healing (i.e., negative wound pressure therapy).


  • G codes for telehealth consultations (G0425-G0427) have been revised to apply both to initial and emergency department services.

The largest number of changes (209 additions, 27 revisions, and 28 deletions) affects G codes used to report quality indicators for the Physician Quality Reporting System (PQRS). Eligible professionals (EPs) who successfully report on quality measures in the PQRS are eligible for a 0.5 percent Medicare payment incentive for years 2012-2014. In 2015, EPs and groups that don’t report quality data successfully will face a 1.5 percent payment reduction in Medicare payments, and a two percent reduction for 2016.