HCPCS 2017: Which Supplies & Services Made the Leap Away From C Codes?

Fri, Jan 20, 2017 --

Coding Updates

HCPCS 2017 C code changes

In the world of HCPCS, C codes are a special bunch. CMS initially created C codes for use on Hospital Outpatient Prospective Payment System claims, but rule changes now allow a limited number of other providers to use the codes, too, such as Critical Access Hospitals and Indian Health Service hospitals.

Restrictions on reporting C codes matter because they aren’t intended for physician use. And that adds some complexity to coverage and reimbursement.

Below are 2016 C codes that moved to other sections in HCPCS 2017. Having a non-C code doesn’t automatically equate to coverage or reimbursement, but it’s worth checking whether your payer will cover the new codes relevant to you. The codes are listed under the range names provided by HCPCS 2017.

Chemotherapy Drugs

  • Daratumumab
    • 2016: C9476, Injection, daratumumab, 10 mg
    • 2017: J9145, Injection, daratumumab, 10 mg
  • Elotuzumab
    • 2016: C9477, Injection, elotuzumab, 1 mg
    • 2017: J9176, Injection, elotuzumab, 1 mg
  • Irinotecan liposome
    • 2016: C9474, Injection, irinotecan liposome, 1 mg
    • 2017: J9205, Injection, irinotecan liposome, 1 mg
  • Necitumumab
    • 2016: C9475, Injection, necitumumab, 1 mg
    • 2017: J9295, Injection, necitumumab, 1 mg
  • Talimogene laherparepvec
    • 2016: C9472, Injection, talimogene laherparepvec, 1 million plaque forming units (PFU)
    • 2017: J9325, Injection, talimogene laherparepvec, per 1 million plaque forming units
  • Trabectedin
    • 2016: C9480, Injection, trabectedin, 0.1 mg
    • 2017: J9352, Injection, trabectedin, 0.1 mg

Clotting Factors

  • Idelvion
    • 2016: C9139, Injection, factor IX, albumin fusion protein (recombinant), Idelvion, 1 I.U.
    • 2017: J7202, Injection, factor IX, albumin fusion protein, (recombinant), Idelvion, 1 I.U.
  • Nuwiq
    • 2016: C9138, Injection, factor VIII (antihemophilic factor, recombinant) (Nuwiq), 1 I.U.
    • 2017: J7209, Injection, factor VIII, (antihemophilic factor, recombinant), (Nuwiq), 1 I.U.
  • Pegylated factor VIII
    • 2016: C9137, Injection, factor VIII (antihemophilic factor, recombinant) pegylated, 1 I.U.
    • 2017: J7207, Injection, factor VIII, (antihemophilic factor, recombinant), pegylated, 1 I.U.

Diagnostic and Therapeutic Radiopharmaceuticals

  • Choline C-11
    • 2016: C9461, Choline C 11, diagnostic, per study dose
    • 2017: A9515, Choline C-11, diagnostic, per study dose up to 20 millicuries

Drugs Administered by Injection

  • Argatroban
    • 2016: C9121, Injection, argatroban, per 5 mg
    • 2017: J0883, Injection, argatroban, 1 mg (for non-ESRD use)
  • Aripiprazole lauroxil
    • 2016: C9470, Injection, aripiprazole lauroxil, 1 mg
    • 2017: J1942, Injection, aripiprazole lauroxil, 1 mg
  • Mepolizumab
    • 2016: C9473, Injection, mepolizumab, 1 mg
    • 2017: J2182, Injection, mepolizumab, 1 mg
  • Reslizumab
    • 2016: C9481, Injection, reslizumab, 1 mg
    • 2017: J2786, Injection, reslizumab, 1 mg
  • Sebelipase alfa
    • 2016: C9478, Injection, sebelipase alfa, 1 mg
    • 2017: J2840, Injection, sebelipase alfa, 1 mg

Miscellaneous Drugs

  • Ciprofloxacin otic suspension
    • 2016: C9479, Instillation, ciprofloxacin otic suspension, 6 mg
    • 2017: J7342, Installation, ciprofloxacin otic suspension, 6 mg
  • Hymovis
    • 2016: C9471, Hyaluronan or derivative, Hymovis, for intra-articular injection, 1 mg
    • 2017: J7322, Hyaluronan or derivative, Hymovis, for intra-articular injection, 1 mg

Procedures/Professional Services (And CPT®)

  • Dermal filler injection for LDS
    • 2016: C9800, Dermal injection procedure(s) for facial lipodystrophy syndrome (LDS) and provision of Radiesse or Sculptra dermal filler, including all items and supplies
    • 2017: G0429, Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (LDS) (e.g., as a result of highly active antiretroviral therapy)
  • Laryngoscopy with injection
    • 2016: C9742, Laryngoscopy, flexible fiberoptic, with injection into vocal cord(s), therapeutic, including diagnostic laryngoscopy, if performed
    • 2017: 31573, Laryngoscopy, flexible; with therapeutic injection(s) (e.g., chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral
    • 2017: 31574, Laryngoscopy, flexible; with injection(s) for augmentation (e.g., percutaneous, transoral), unilateral
  • Peri-prostatic material placement
    • 2016: C9743, Injection/implantation of bulking or spacer material (any type) with or without image guidance (not to be used if a more specific code applies)
    • 2017: 0438T, Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance

Skin Substitutes and Biologicals

  • PuraPly
    • 2016: C9349, PuraPly, and PuraPly antimicrobial, any type, per square centimeter
    • 2017: Q4172, PuraPly or PuraPly AM, per square centimeter

How About You?

Did you find any good news in the HCPCS 2017 updates?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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