Additional Information
Book Details
Abstract
For quick, accurate, and efficient coding, pick the market-leading HCPCS reference! From coding expert Carol J. Buck, 2016 HCPCS Level II, Standard Edition provides an easy-to-use guide to the latest Healthcare Common Procedure Coding System codes. It helps you locate specific codes, comply with coding regulations, optimize reimbursement, report patient data, code Medicare cases, and more. With this standard edition, you can focus on the basics of HCPCS coding — so you save money!
- At-a-glance code listings and distinctive symbols identify all new, revised, and deleted codes for 2016.
- Drug code annotations identify brand-name drugs as well as drugs that appear on the National Drug Class (NDC) directory and other Food and Drug Administration (FDA) approved drugs.
- Information on coverage provides alerts when codes have special instructions, are not valid or covered by Medicare, or may be paid at the carrier’s discretion.
- Jurisdiction symbols show the appropriate contractor to be billed for suppliers submitting claims to Medicare contractors, Part B carriers, and Medicare administrative contractors submitting for DMEPOS services provided.
- Color-coded Table of Drugs makes it easier to find specific drug information.
- Codingupdates.com website includes quarterly updates to HCPCS codes and content, and the opportunity to sign up for e-mail notifications of the newest updates.
- UPDATED 2016 official code set ensures compliance with current HCPCS standards, for fast and accurate coding.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Cover | Cover | ||
2016 HCPCS Level II STANDARD EDITION | i | ||
Copyright Page | ii | ||
DEVELOPMENT OF THIS EDITION | iii | ||
DEDICATION | iv | ||
TABLE OF CONTENTS | v | ||
INTRODUCTION | vii | ||
GUIDE TO USING THE 2016 HCPCS LEVEL II CODES | viii | ||
SYMBOLS AND CONVENTIONS | ix | ||
2016 HCPCS UPDATES | xi | ||
2016 INDEX | 1 | ||
2016 TABLE OF DRUGS | 41 | ||
2016: HCPCS LEVEL II NATIONAL CODES | 91 | ||
LEVEL II NATIONAL MODIFIERS | 92 | ||
Ambulance Modifiers | 101 | ||
TRANSPORT SERVICES INCLUDING AMBULANCE (A0000‑A0999) | 101 | ||
MEDICAL AND SURGICAL SUPPLIES (A4000‑A6513) | 102 | ||
Vascular Catheters | 105 | ||
Incontinence Appliances and Care Supplies | 105 | ||
External Urinary Supplies | 106 | ||
Ostomy Supplies | 107 | ||
Miscellaneous Supplies | 109 | ||
Supplies for Respiratory and Oxygen Equipment | 111 | ||
Supplies for Other Durable Medical Equipment | 112 | ||
Supplies for Radiological Procedures | 112 | ||
Miscellaneous Supplies | 112 | ||
Supplies for Dialysis | 112 | ||
Additional Ostomy Supplies | 114 | ||
Additional Incontinence Appliances/Supplies | 115 | ||
Supplies for Either Incontinence or Ostomy Appliances | 115 | ||
Diabetic Shoes, Fitting, and Modifications | 115 | ||
Dressings | 116 | ||
GRADIENT COMPRESSION STOCKINGS (A6530‑A6549) | 121 | ||
WOUND CARE (A6550) | 122 | ||
RESPIRATORY DURABLE MEDICAL EQUIPMENT, INEXPENSIVE AND ROUTINELY PURCHASED (A7000‑A7509) | 122 | ||
HELMETS (A8000‑A8004) | 123 | ||
ADMINISTRATIVE, MISCELLANEOUS, AND INVESTIGATIONAL (A9000‑A9999) | 124 | ||
Supplies for Radiology Procedures (Radiopharmaceuticals) | 124 | ||
Miscellaneous Service Component | 126 | ||
ENTERAL AND PARENTERAL THERAPY (B4000‑B9999) | 127 | ||
Enteral Formulae and Enteral Medical Supplies | 127 | ||
Parenteral Nutritional Solutions and Supplies | 128 | ||
Enteral and Parenteral Pumps | 129 | ||
CMS HOSPITAL OUTPATIENT PAYMENT SYSTEM (C1000‑C9999) | 130 | ||
DURABLE MEDICAL EQUIPMENT (E0100‑E1841) | 140 | ||
Canes | 140 | ||
Crutches | 140 | ||
Walkers | 140 | ||
Attachments | 141 | ||
Commodes | 141 | ||
Decubitus Care Equipment | 141 | ||
Heat/Cold Application | 142 | ||
Bath and Toilet Aids | 142 | ||
Hospital Beds and Accessories | 143 | ||
Oxygen and Related Respiratory Equipment | 144 | ||
IPPB Machines | 146 | ||
Humidifiers/Nebulizers/Compressors for Use with Oxygen IPPB Equipment | 146 | ||
Suction Pump/Room Vaporizers | 146 | ||
Monitoring Equipment | 146 | ||
Pacemaker Monitor | 146 | ||
Patient Lifts | 147 | ||
Pneumatic Compressor and Appliances | 147 | ||
Ultraviolet Cabinet | 148 | ||
Safety Equipment | 148 | ||
Restraints | 148 | ||
Transcutaneous and/or Neuromuscular Electrical Nerve Stimulators (TENS) | 148 | ||
Infusion Supplies | 149 | ||
Traction Equipment: All Types and Cervical | 149 | ||
Traction: Overdoor | 150 | ||
Traction: Extremity | 150 | ||
Traction: Pelvic | 150 | ||
Trapeze Equipment, Fracture Frame, and Other Orthopedic Devices | 150 | ||
Wheelchair Accessories | 150 | ||
Rollabout Chair and Transfer System | 152 | ||
Wheelchair: Fully Reclining | 152 | ||
Wheelchair: Semi‑reclining | 153 | ||
Wheelchair: Standard | 153 | ||
Wheelchair: Amputee | 153 | ||
Wheelchair: Special Size | 153 | ||
Wheelchair: Lightweight | 154 | ||
Wheelchair: Heavy Duty | 154 | ||
Whirlpool Equipment | 155 | ||
Additional Oxygen Related Equipment | 155 | ||
Artificial Kidney Machines and Accessories | 155 | ||
Jaw Motion Rehabilitation System and Accessories | 156 | ||
Other Orthopedic Devices | 156 | ||
MISCELLANEOUS (E1902‑E2120) | 157 | ||
Wheelchair Assessories | 157 | ||
Negative Pressure | 160 | ||
Speech Device | 160 | ||
Wheelchair, Cushion and Protection | 160 | ||
SKIN PROTECTION, WHEELCHAIR (E2622‑E2625) | 161 | ||
ARM SUPPORT (E2626‑E2633) | 161 | ||
GAIT TRAINER (E8000‑E8002) | 161 | ||
TEMPORARY PROCEDURES/PROFESSIONAL SERVICES (G0000‑G9999) | 162 | ||
Administration, Vaccine | 162 | ||
Semen Analysis | 162 | ||
Screening, Cervical | 162 | ||
Screening, Prostate | 162 | ||
Screening, Colorectal | 162 | ||
Training Services, Diabetes | 163 | ||
Screening, Glaucoma | 163 | ||
Screening, Colorectal, Other | 163 | ||
Screening, Cytopathology | 163 | ||
Trimming, Nail | 163 | ||
Service, Nursing and OT | 164 | ||
Study, SEXA | 164 | ||
Screening, Cytopathology, Other | 164 | ||
Services, Allied Health | 164 | ||
Wound Closure | 165 | ||
Team Conference | 165 | ||
Therapy, Activity | 165 | ||
Physician Services | 166 | ||
Destruction | 166 | ||
Mammography | 166 | ||
Imaging, PET | 167 | ||
Therapeutic Procedures | 167 | ||
Physician Service, Diabetic | 167 | ||
Foot Care | 167 | ||
Demonstration, INR | 167 | ||
Imaging, PET | 168 | ||
SNCT | 168 | ||
Dialysis, Emergency | 168 | ||
Injection, Arthrography | 168 | ||
Removal, Cerumen | 168 | ||
Placement, Occlusive Device | 168 | ||
Therapy, Nutrition | 168 | ||
Blinded Procedure | 169 | ||
Therapy, Hyperbaric Oxygen | 169 | ||
Angiography | 169 | ||
Diagnostic | 169 | ||
Stimulation, Electrical | 169 | ||
Angiography, Arthroscopy | 169 | ||
Procedure, Non‑Covered | 169 | ||
Therapy, Electromagnetic | 169 | ||
Other | 169 | ||
Services, Pulmonary Surgery | 170 | ||
Laboratory | 170 | ||
Therapy, Electromagnetic | 170 | ||
Fee, Pharmacy | 170 | ||
Hospice | 170 | ||
Radiosurgery, Robotic | 170 | ||
Islet Cell | 170 | ||
Aspiration, Bone Marrow | 171 | ||
Mapping, Vessel | 171 | ||
Services, Observation and ED | 171 | ||
Ultrasound, AAA | 172 | ||
Team, Trauma Response | 172 | ||
Assessment/Intervention | 172 | ||
Home Sleep Study Test | 173 | ||
Examination, Initial Medicare | 173 | ||
Electrocardiogram | 173 | ||
Telehealth | 173 | ||
Services, Social, Psychological | 173 | ||
Treatment, Bone | 174 | ||
Pathology, Surgical | 174 | ||
Educational Services, Rehabilitation, Telehealth, and Miscellaneous | 174 | ||
Tositumomab | 177 | ||
Guidance | 177 | ||
Treatment, Radiation | 177 | ||
Drugs | 178 | ||
Documentation | 178 | ||
Influenza A (H1N1) and Warfarin Responsiveness Testing | 196 | ||
BEHAVIORAL HEALTH AND/OR SUBSTANCE ABUSE TREATMENT SERVICES (H0001‑H9999) | 214 | ||
DRUGS OTHER THAN CHEMOTHERAPY (J0100‑J8999) | 216 | ||
Miscellaneous Drugs and Solutions | 232 | ||
Immunosuppressive Drugs (Includes Non‑injectibles) | 234 | ||
Inhalation Solutions | 235 | ||
Other | 238 | ||
CHEMOTHERAPY DRUGS (J9000‑J9999) | 239 | ||
TEMPORARY CODES ASSIGNED TO DME REGIONAL CARRIERS (K0000‑K9999) | 243 | ||
Wheelchairs and Accessories | 243 | ||
ORTHOTICS (L0100‑L4999) | 249 | ||
Orthotic Devices: Spinal | 249 | ||
Cervical | 249 | ||
Multiple Post Collar | 249 | ||
Thoracic | 249 | ||
Thoracic‑Lumbar‑Sacral | 249 | ||
Anterior‑Posterior‑Lateral Rotary‑Control | 249 | ||
Sacroilliac, Lumbar, Sacral Orthosis | 252 | ||
Cervical‑Thoracic‑Lumbar‑Sacral | 255 | ||
Anterior‑Posterior‑Lateral Control | 255 | ||
HALO Procedure | 255 | ||
Additions to Spinal Orthoses | 255 | ||
Orthotic Devices: Scoliosis Procedures (L1000‑L1520) | 255 | ||
Scoliosis: Cervical‑Thoracic‑Lumbar‑Sacral (CTLSO) (Milwaukee) | 255 | ||
Correction Pads | 255 | ||
Scoliosis: Thoracic‑Lumbar‑Sacral (Low Profile) | 256 | ||
Other Scoliosis Procedures | 256 | ||
Orthotic Devices: Lower Limb | 256 | ||
Hip: Flexible | 256 | ||
Legg Perthes | 257 | ||
Knee (KO) | 257 | ||
Ankle‑Foot (AFO) | 258 | ||
Hip‑Knee‑Ankle‑Foot (or Any Combination) | 258 | ||
Torsion Control | 259 | ||
Fracture Orthoses | 259 | ||
Additions to Fracture Orthosis | 259 | ||
Additions to Lower Extremity Orthosis | 259 | ||
Shoe‑Ankle‑Shin‑Knee | 259 | ||
Additions to Straight Knee or Offset Knee Joints | 260 | ||
Gluteal/Ischial Weight Bearing | 260 | ||
Additions to Pelvic and Thoracic Control | 261 | ||
General Additions | 261 | ||
Foot (Orthopedic Shoes) | 261 | ||
Insert, Removable, Molded to Patient Model | 261 | ||
Arch Support, Removable, Premolded | 262 | ||
Arch Support, Non‑removable, Attached to Shoe | 262 | ||
Abduction and Rotation Bars | 262 | ||
Orthopedic Footwear | 262 | ||
Shoe Modifications | 263 | ||
Lifts | 263 | ||
Wedges | 263 | ||
Heels | 264 | ||
Additions to Orthopedic Shoes | 264 | ||
Transfer or Replacement | 264 | ||
Orthotic Devices: Upper Limb | 264 | ||
Shoulder | 264 | ||
Elbow | 265 | ||
Wrist‑Hand‑Finger Orthosis (WHFO) | 265 | ||
Additions and Extensions | 265 | ||
External Power | 266 | ||
Other Wrist‑Hand‑Finger Orthoses: Custom Fitted | 266 | ||
Shoulder‑Elbow‑Wrist‑Hand Orthosis (SEWHO) | 267 | ||
Abduction Positioning: Custom Fitted | 267 | ||
Additions to Mobile Arm Supports and SEWHO | 267 | ||
Fracture Orthoses | 267 | ||
Specific Repair | 267 | ||
Repairs | 268 | ||
Ancillary Orthotic Services | 268 | ||
PROSTHETICS (L5000‑L9999) | 268 | ||
Lower Limb (L5000‑L5999) | 268 | ||
Partial Foot | 268 | ||
Ankle | 268 | ||
Below Knee | 269 | ||
Knee Disarticulation | 269 | ||
Above Knee | 269 | ||
Hip Disarticulation | 269 | ||
Hemipelvectomy | 269 | ||
Endoskeleton: Below Knee | 269 | ||
Endoskeletal: Above Knee | 269 | ||
Endoskeletal: Hip Disarticulation | 269 | ||
Endoskeletal: Hemipelvectomy | 269 | ||
Immediate Postsurgical or Early Fitting Procedures | 269 | ||
Initial Prosthesis | 269 | ||
Preparatory Prosthesis | 270 | ||
Additions to Lower Extremity | 270 | ||
Additions to Test Sockets | 270 | ||
Additions to Socket Variations | 270 | ||
Additions to Socket Insert and Suspension | 271 | ||
Additions/Replacements to Feet‑Ankle Units | 272 | ||
Additions to Exoskeletal–Knee‑Shin System | 272 | ||
Component Modification | 272 | ||
Endoskeletal | 273 | ||
Upper Limb | 274 | ||
Partial Hand | 274 | ||
Wrist Disarticulation | 274 | ||
Below Elbow | 274 | ||
Elbow Disarticulation | 274 | ||
Above Elbow | 275 | ||
Shoulder Disarticulation | 275 | ||
Interscapular Thoracic | 275 | ||
Immediate and Early Postsurgical Procedures | 275 | ||
Endoskeletal: Below Elbow | 275 | ||
Endoskeletal: Elbow Disarticulation | 275 | ||
Endoskeletal: Above Elbow | 275 | ||
Endoskeletal: Shoulder Disarticulation | 275 | ||
Endoskeletal: Interscapular Thoracic | 275 | ||
Additions to Upper Limb | 276 | ||
Terminal Devices | 277 | ||
Hooks | 277 | ||
Hands | 278 | ||
Replacement Sockets | 278 | ||
Gloves for Above Hands | 278 | ||
Hand Restoration | 278 | ||
External Power | 278 | ||
Base Devices | 278 | ||
Terminal Devices | 279 | ||
Elbow | 279 | ||
Wrist | 279 | ||
Battery Components | 279 | ||
Other/Repair | 279 | ||
General | 280 | ||
Breast Prostheses | 280 | ||
Nasal, Orbital, Auricular Prosthesis | 280 | ||
Trusses | 280 | ||
Prosthetic Socks | 280 | ||
Prosthetic Implants | 281 | ||
Larynx, Tracheoesophageal | 281 | ||
Breast | 281 | ||
Urinary System | 281 | ||
Head (Skull, Facial Bones, and Temporomandibular Joint) | 282 | ||
Upper Extremity | 282 | ||
Lower Extremity (Joint: Knee, Ankle, Toe) | 282 | ||
Miscellaneous Muscular‑Skeletal | 282 | ||
Cardiovascular System | 283 | ||
Neurostimulator | 283 | ||
Unspecified | 283 | ||
OTHER MEDICAL SERVICES (M0000‑M0301) | 284 | ||
LABORATORY SERVICES (P0000‑P9999) | 285 | ||
Chemistry and Toxicology Tests | 285 | ||
Pathology Screening Tests | 285 | ||
Microbiology Tests | 285 | ||
Miscellaneous Pathology | 285 | ||
TEMPORARY CODES ASSIGNED BY CMS (Q0000‑Q9999) | 288 | ||
Cardiokymography | 288 | ||
Chemotherapy | 288 | ||
Smear, Papanicolaou | 288 | ||
Equipment, X‑Ray, Portable | 288 | ||
Laboratory | 288 | ||
Drugs | 288 | ||
Miscellaneous Devices | 290 | ||
Fee, Pharmacy | 291 | ||
Lens, Intraocular | 291 | ||
Solutions and Drugs | 291 | ||
Brachytherapy Radioelements | 292 | ||
Telehealth | 292 | ||
Drugs | 292 | ||
Test, Skin | 292 | ||
Supplies, Cast | 292 | ||
Drugs | 293 | ||
Skin Substitutes | 293 | ||
Hospice Care | 294 | ||
Miscellaneous | 295 | ||
Contrast | 295 | ||
DIAGNOSTIC RADIOLOGY SERVICES (R0000‑R9999) | 297 | ||
Transportation/Setup of Portable Equipment | 297 | ||
TEMPORARY NATIONAL CODES ESTABLISHED BY PRIVATE PAYERS (S0000‑S9999) | 298 | ||
TEMPORARY NATIONAL CODES ESTABLISHED BY MEDICAID (T1000‑T9999) | 313 | ||
Not Valid For Medicare | 313 | ||
VISION SERVICES (V0000‑V2999) | 316 | ||
Frames | 316 | ||
Spectacle Lenses | 316 | ||
Single Vision, Glass or Plastic | 316 | ||
Bifocal, Glass or Plastic | 316 | ||
Trifocal, Glass or Plastic | 317 | ||
Variable Asphericity | 317 | ||
Contact Lenses | 317 | ||
Low Vision Aids | 318 | ||
Prosthetic Eye | 318 | ||
Intraocular Lenses | 319 | ||
Miscellaneous | 319 | ||
HEARING SERVICES (V5000‑V5999) | 320 | ||
Speech‑Language Pathology Services | 322 |