Impact of 2024 HCPCS Updates on Healthcare Providers

16-Aug-2024

HCPCS stands for Healthcare Common Procedure Coding System, a standardized language for medical billing in the United States. It ensures the smooth processing of health insurance claims by Medicare and other insurers, facilitating clear communication between healthcare providers and payers. In order to make the healthcare system smooth and accessible, you need to understand the concept along with HCPCS quarterly updates. Let’s begin this article and get to know the impact of 2024 HCPCS updates in the healthcare system.

HCPCS comprises two levels of coding systems:

• Level I

Consists of Current Procedural Terminology (CPT®) codes maintained by the American Medical Association (AMA). These are five-digit numeric codes representing various medical services provided by healthcare professionals, such as office visits, surgeries, and diagnostic procedures.

• Level II

Identifies products, services, and supplies not included in CPT® codes. These codes are alphanumeric, starting with a single letter followed by four numbers. They cover items like ambulance services, durable medical equipment, prosthetics, orthotics, and certain medications that are not captured by Level I codes.

HCPCS Quarterly Updates

The HCPCS Level II quarterly update for July 2024 has been released and is now available on the Centers for Medicare & Medicaid Services (CMS) website. This update brings significant changes, including the addition of new codes, the discontinuation of others, and various adjustments to existing codes.

Here’s a comprehensive overview of what’s new:

New Codes Added

This quarter introduces a total of 134 new codes, enhancing the coding system’s ability to accurately represent contemporary medical procedures and services. Highlights include:

• A9506: A new A code for diagnostic and therapeutic radiopharmaceuticals, specifically for the graphite crucible used in the preparation of technetium tc 99m-labeled carbon aerosol.
• C Codes:
  • C1605: For leadless dual chamber pacemakers, including all components necessary for implantation. This code should be billed alongside CPT codes 0801T and 0795T.
  • C1606: For a disposable adapter that attaches an ultrasound system to an upper gastrointestinal endoscope.
  • C9901: For endoscopic defect closure within the entire gastrointestinal tract, including both upper endoscopy and colonoscopy procedures.
• G Codes: New codes for patient-caregiver management services (G0519-G0528) and services conducted in the Center for Medicare and Medicaid Innovation (CMMI) model (G0529-G0531). Additionally, G9037-G9038 covers interprofessional and co-management services.
• J Codes: There are 23 new codes for injectable drugs.
• Q Codes: A total of 25 new codes for wound supplies (Q4311-Q4333) and injectables (Q5137-Q5138).

Discontinued Codes

Nine codes are being discontinued effective July 1, 2024. These include, C9113, C9166, C9167, J2780, J9371, Q4210, Q4277 and S0164.

Long Description Changes

This update includes changes to the long descriptions of 32 codes, primarily to correct grammatical errors. Notably, there is an increase in dosage for one Q code:

• Q2055: The description now indicates "up to 510 million autologous b-cell maturation antigen (bcma) directed car-positive t cells," an increase from the previous 460 million.

Payment Changes

Three codes will see changes in payment structures starting July 1, 2024:

• A9593: Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie
• A9594: Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurie
• C9790: Histotripsy (non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including image guidance

The pricing indicators for the A code are 57 (Other carrier priced), and for the C code, it is 53 (Statute). The purpose of this Change Request (CR) is to notify Medicare contractors that the HCPCS file's quarterly update is currently accessible for download. The entire HCPCS file, which is updated and published on a quarterly basis, contains all of the codes for the July 2024 quarter—new, updated, revised, and discontinued.

HCPCS Quarterly Updates Impact on  Healthcare Providers

Significant adjustments are included in the 2024 HCPCS quarterly updates to improve the efficiency and accuracy of healthcare providers' billing. The implementation of 134 new codes, such as those for leadless dual chamber pacemakers and disposable ultrasound system adapters, enables healthcare professionals to accurately record and charge for sophisticated procedures and equipment. This guarantees that providers are fairly compensated for the services they deliver and lowers the possibility of claim denials.

Along with new codes, the upgrades also contain corrections and changes to lengthy descriptions, which enhance the codes' specificity and clarity. This improvement reduces errors and expedites the claims procedure, which speeds up payment and lessens the administrative strain on medical professionals. Improved coordination and documentation of comprehensive care, especially for difficult situations, is made possible by the addition of new G codes for patient-caregiver management and interprofessional services. This leads to better patient outcomes.

Additionally, new technologies are reflected in the updates with codes for cutting-edge treatments like pacemaker insertion and histotripsy. This enables healthcare professionals to stay abreast of medical developments and provide patients with better treatment alternatives. The financial planning and reimbursement strategies of providers are also impacted by modifications in the payment for particular codes, such as those for Gallium ga-68 diagnostic agents. Providers can better manage their revenue cycle and maintain accurate and efficient billing processes while continuing to offer high-quality care by keeping themselves informed about these alterations.