New HCPCS Q Codes Effective July 1, 2018
Are You Correctly Handling These New HCPCS Q Codes?
You’re probably just getting comfortable with your 2018 edition of HCPCS level II code book, but you’ll have to make a few additional changes to your reporting. CMS has released five new HCPCS Level II codes, effective July 1, 2018. All the new codes are Q codes (assigned on a temporary basis) that will be used to designate treatments for knee pain, opioid addiction, cystic fibrosis, and hemophilia.
Read on to be sure you’re on top of the latest the HCPCS codes 2018 changes.
Welcome Two New Codes for Sublocade
You now have a set of two related codes for Sublocade (a drug used for treatment of moderate to severe opioid use disorder in adult patients) – Q9991 (less than or equal to 100 mg) and Q9992 (greater than 100 mg).
To distinguish the two codes, watch the mg. The diagnosis codes connected to these codes will be in the F11.2 – (Opioid dependence) subcategory. Some payers are expanding that list to subcategories like F11.1- (Opioid abuse) and F11.9- (Opioid use, unspecified). Find out if your payer has any specific policy for Sublocade. The Medicare coverage status for these codes are C.
Note New Code for Zilretta
You’ll report Zilretta (drug for injection into osteoarthritic knees) with new Q code Q9993 (1 mg) even though there is no drug name mentioned in the code’s descriptor. The diagnosis codes linked to this code will be under M17.-. The coverage indicator for Q9993 will be D.
Refer This New Code for Relizorb
Q9994 is added to the HCPCS Level II code set effective July 1. You’ll report Relizorb (a drug that helps break down fat in enteral tube formula prior to patient ingestion) with the new code. The coverage indicator for this code will be 1 and will not be payable by Medicare.
Add This New Q Code for Hemlibra
Finally, you’ll report Hemlibra (a drug given to patients with hemophilia) with the new code – Q9995 (Injection, emicizumab-kxwh, 0.5 mg). The diagnosis code associated with this medication is D66 and coverage indicator will be C. Make sure you look up specific payer policies for coverage information.
Ensure Proper Pay for These Services
These HCPCS Level II codes are often overlooked or used improperly. TCI’s HCPCS Level II code book is an effective and cost-friendly way to ensure your organization is getting paid for these services. The book includes far more than a listing of over 5,000 + HCPCS codes—it’s jam packed with everything you need for quick and accurate coding, including fast HCPCS code lookup, rules for code usage, tips on code selection, anatomical illustrations, and the latest HCPCS code updates.
