Here’s What’s New in Q2 for CCI, MPFS, and HCPCS


It’s almost April! In addition to a potential end to the yellow pine pollen covering every surface outside my home (yours, too?), April means second quarter updates to Correct Coding Initiative (CCI) edits, fee schedules, and HCPCS. Ready for some highlights? Let’s go!

CCI for Moderate Sedation Goes Retro

If you read this blog regularly, you know that the big CCI news for moderate sedation is the retroactive deletion of several erroneously added edits. The list of deletions is almost identical to the original announcement, but there is one difference.

The CCI contractor originally stated it was an error to have edits bundling moderate sedation codes 99151-+99153 into 45990 (Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic). But the April 2017 version of CCI keeps in place the moderate sedation edits for 45990, which you may have noticed refers to general, spinal, or epidural anesthesia.

Remember: Retroactive deletion back to the date of the creation of the edits means it’s as if the edits never existed. If you received denials for moderate sedation based on those specific edits, you may appeal the denial (or follow your payer’s preferred process) to get those denied codes paid after the April 1 update is implemented.

38,000 to go: There are more than 38,000 changes in the quarterly update for physician/practitioner CCI edits (and for the outpatient CCI version, too), including many affecting lab and nerve block codes, so be sure your CCI resource is up to date and that you check for edits before you submit your claims.

MPFS Goes Back in Time, Too

Retroactive changes aren’t limited just to CCI. The Medicare Physician Fee Schedule (MPFS) will have some changes implemented April 3 but effective back on Jan. 1, 2017. MLN Matters MM9977 offers a list of changes. Here’s a quick look:

  • Presumptive drug test codes G0477-G0479 change to procedure status I, meaning the codes aren’t valid for Medicare (adding to a grab-bag of changes related to these codes for 2017)
  • Spine stabilization codes 22867 and 22869 change the assistant surgery indicator from 1 (no payment) to 2 (payment allowed)
  • Ophthalmic biometry codes (professional component) 76519-26 and 92136-26 get bilateral surgery indicator 3
  • Physical therapy eval codes 97161-97163 see a PE RVU increase from 0.98 to 1.00
  • Occupational therapy eval codes 97165-97167 see a PE RVU increase from 0.91 to 1.32
  • Occupational therapy re-evaluation code 97168 sees a PE RVU increase from 0.65 to 0.93.

Tip: MPFS isn’t the only Medicare fee schedule that gets an April update. Confirm that you have current information for areas like DMEPOS, ASC, and drugs, too, if they affect you.

HCPCS Gains Some C Codes

Finally, for you outpatient coders, there are some new OPPS pass-through drug HCPCS codes effective April 1:

  • C9484 (Injection, eteplirsen, 10 mg)
  • C9485 (Injection, olaratumab, 10 mg)
  • C9486 (Injection, granisetron extended release, 0.1 mg)
  • C9487 (Ustekinumab, for intravenous injection, 1 mg)
  • C9488 (Injection, conivaptan hydrochloride, 1 mg).

How About You?

Which quarterly updates affect you? Did you hold your moderate sedation claims until the CCI change?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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