Hcpcs Level Ii Coding Procedures

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services 7500
Security Boulevard, Mail Stop C5-09-14
Baltimore, Maryland 21244-1850

HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)
LEVEL II CODING PROCEDURES
This information provides a description of the procedures the Centers for Medicare & Medicaid
Services (CMS) follows in processing HCPCS Level II applications and making coding decisions.
FOR FURTHER INFORMATION CONTACT:
Please submit an inquiry to the HCPCS mailbox at HCPCS@cms.hhs.gov.
HCPCS BACKGROUND INFORMATION
Each year in the United States (U.S.), health care insurers process over five billion claims for
payment. For Medicare and other health insurance programs to ensure that these claims are
processed in an orderly and consistent manner, standardized coding systems are essential. The
HCPCS Level II Code Set is one of the standard, national medical code sets specified by the
Health Insurance Portability and Accountability Act (HIPAA) for this purpose. The HCPCS is
divided into two principal subsystems, referred to as Level I and Level II.
HCPCS Level I is comprised of Current Procedural Terminology (CPT®), a numeric coding
system maintained by the American Medical Association (AMA). CPT® is a uniform coding
system consisting of descriptive terms and codes that are used primarily to identify medical
services and procedures furnished by physicians and other health care professionals. These health
care professionals use CPT® to identify services and procedures for which they bill public or
private health insurance programs. CPT® codes are republished and updated annually by the
AMA.
HCPCS Level II is a standardized coding system that is used primarily to identify drugs,
biologicals and non-drug and non-biological items, supplies, and services not included in the
CPT® code set jurisdiction, such as ambulance services and durable medical equipment,
prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because
Medicare and other insurers cover a variety of services, supplies, and equipment that are not
identified by CPT® codes, HCPCS Level II codes were established for submitting claims for
these items. HCPCS Level II codes are alpha-numeric codes because they consist of a single
alphabetical letter followed by four numeric digits, while CPT® codes primarily are identified
using five numeric digits.
HISTORY
The development and use of HCPCS Level II codes began in the 1980s. Concurrent to the use of
Level II codes, there were also Level III codes. HCPCS Level III were developed and used by
Medicaid State agencies, Medicare contractors, and private insurers in their specific programs or
local areas of jurisdiction. For purposes of Medicare, Level III codes were also referred to as
local codes. Local codes were established when an insurer preferred that suppliers use a local
code to identify a service, for which there is no Level I or Level II code, rather than using a

"miscellaneous or not otherwise classified code."
HIPAA required the Secretary of the Department of Health and Human Services (HHS) to adopt
standards for coding systems that are used for reporting health care transactions. Thus,
regulations were published in the Federal Register on August 17, 2000 (65 FR 50312), to
implement standardized coding systems under HIPAA. These regulations provided for the
elimination of Level III local codes by October 2002, at which time, the Level I and Level II
code sets could be used. The elimination of local codes was postponed, as a result of section
532(a) of BIPA, which continued the use of local codes through December 31, 2003.
The regulation that was published on August 17, 2000 (45 CFR 162.1002), to implement the
HIPAA requirement for standardized coding systems established the HCPCS Level II codes as
the standardized coding system for describing and identifying health care equipment and
supplies in health care transactions that are not within the CPT code set jurisdiction. The
HCPCS Level II coding system was selected as the standardized coding system because of its
wide acceptance among both public and private insurers.
AUTHORITY
The Secretary of HHS has delegated authority under HIPAA to the AMA and CMS to maintain and
distribute HCPCS Level I and Level II codes, respectively.
HCPCS LEVEL II CODES
The HCPCS Level II coding system is a comprehensive, standardized system that classifies similar
items or services that are medical in nature into categories for the purpose of efficient claims
processing.
For each alpha-numeric HCPCS code, there is descriptive terminology that identifies a category of
like items. These codes are used primarily for billing purposes. For example, suppliers use HCPCS
Level II codes to identify items on claim forms that are being billed to a private or public health
insurer. Currently, there are national HCPCS codes representing almost 8,000 separate categories of
like items or services that encompass products from different manufacturers. When submitting
claims, suppliers are required to use one of these codes to identify the items they are billing.
HCPCS is a system for identifying items and certain services. It is not a methodology or system for
making coverage or payment determinations, and the existence of a code does not, of itself,
determine coverage or non-coverage for an item or service. While these codes are used for billing
purposes, decisions regarding the addition, deletion, or revision of HCPCS codes are made
independent of the process for making determinations regarding coverage and payment.
With regard to the Medicare Program, if specific Medicare coverage or payment indicators or
values have not been established for any new HCPCS codes, this may be because a national
Medicare coverage determination and/or fee schedule amounts have not yet been established for
these items. This neither indicates Medicare coverage nor non-coverage. In these cases, until
national Medicare coverage and payment guidelines have been established for these codes, the
Medicare coverage and payment determinations for these items may be made based on the
discretion of the Medicare Administrative Contractors processing claims for these items.

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TYPES OF HCPCS LEVEL II CODES
There are several types of HCPCS Level II codes depending on the purpose of the codes and the
entity with responsibility for establishing and maintaining them.
National HCPCS Level II Codes
National HCPCS Level II codes are maintained by CMS. CMS is responsible for making
decisions about additions, revisions, and deletions to the national alpha-numeric codes. These
codes are for the use of all private and public health insurers.
HCPCS Level II applications are reviewed by a group comprised of physicians and healthcare
professionals within CMS, as well as other pertinent federal agencies such as the Department of
Veterans Affairs and the Department of Defense at regularly scheduled meetings to determine
whether coding requests warrant a change to the HCPCS Level II national code set. This group
of reviewers informs CMS’ decisions.
The application and instructions for requesting that CMS add, revise, or discontinue a HCPCS
Level II code can be accessed at: https://mearis.cms.gov/public/home. CMS may also issue
codes based on the needs of its programs or other federal programs.
Dental Codes
Dental codes, or D codes, are a separate category of national codes. The Current Dental
Terminology (CDT) is published, copyrighted, and licensed by the American Dental
Association (ADA). The CDT lists codes for billing for dental procedures and supplies. While the
CDT codes are considered HCPCS Level II codes, decisions regarding the revision, deletion, or
addition of CDT codes are made by the ADA, not CMS.
Miscellaneous Codes
National codes also include "miscellaneous/not otherwise classified" codes. These codes are used
when a supplier is submitting a bill for an item or service and there is no existing national code that
adequately describes the item or service being billed. The importance of miscellaneous codes is
that they allow suppliers to begin billing immediately for a service or item as soon as it is allowed
to be marketed by the Food and Drug Administration (FDA), even though there is no distinct code
that describes the service or item. A miscellaneous code may be assigned by insurers for use during
the period of time a request for a new code is being considered under the HCPCS review process.
The use of miscellaneous codes also helps avoid the inefficiency and administrative burden of
assigning distinct codes for items or services that are rarely furnished or for which few claims are
expected to be filed. Because of miscellaneous codes, the absence of a specific code for a distinct
category of products does not affect the ability of a supplier to submit claims to private or public
insurers.
In those cases, in which a supplier or manufacturer has been advised to use a miscellaneous code
because there is no existing code that describes a given product, and the supplier or manufacturer
believes that a new code is needed, the supplier or manufacturer may submit a request to modify
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the HCPCS Level II code set in accordance with the established process. The standard process for
requesting a revision to the HCPCS Level II codes is explained later in this document.
Other Notable Codes
•

The C codes (pass-through) were established to permit implementation of section 201 of the
Balanced Budget Refinement Act of 1999. HCPCS C codes are utilized to report drugs,
biologicals, magnetic resonance angiography (MRA), and devices used for CMS’ Medicare
Hospital Outpatient Prospective Payment System (HOPPS). HCPCS C codes are reported for
device categories, new technology procedures, and drugs, biologicals, and
radiopharmaceuticals that do not have other HCPCS code assignments. Non-OPPS hospitals,
Critical Access Hospitals (CAHs), Indian Health Service (IHS) hospitals, and hospitals
located in American Samoa, Guam, Northern Mariana Islands, and the Virgin Islands, as well
as Maryland waiver hospitals, may report these codes at their discretion.
For information about the HOPPS pass-through process, please visit the HOPPS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS

•

The G codes are used to identify professional health care procedures and services that would
otherwise be coded in CPT-4 (the current version of CPT codes) but for which there are no
CPT-4 codes. CMS does not have an application process for G codes, as they are established
internally by CMS to support Medicare claims processing needs. As G codes are part of the
national HCPCS Level II code set, they may also be used by non-Medicare insurers.

•

The G codes and C codes are considered HCPCS Level II codes and as such, these
codes, and changes to them, are included in CMS’ HCPCS Level II updates published
by CMS. The code application procedures described in this document are not for use to
apply for changes to HCPCS C codes and G codes.

•

The Q codes are established to identify drugs, biologicals, and medical equipment or
services not identified by national HCPCS Level II codes, but for which codes are
needed for Medicare claims processing.

Code Modifiers
HCPCS code modifiers are established internally by CMS to facilitate accurate Medicare claims
processing. Modifiers are assigned for use when the information provided by a HCPCS code
descriptor needs to be supplemented to identify specific circumstances that may apply to an item
or service. For example, the UE modifier is used when the item identified by a HCPCS code is
"used equipment," and the NU modifier is used for "new equipment." The HCPCS Level II
modifiers are either alpha-numeric or two letters. HCPCS code modifiers are published as part of
the HCPCS code set at https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/AlphaNumeric-HCPCS. The modifiers appear at the beginning of the file, before alpha-numeric codes.
HCPCS Code Assignment Following Medicare National Coverage Determination (NCD)
Pursuant to section 1862(l)(3)(C)(iv) of the Social Security Act (added by section 731(a) of the
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Medicare Modernization Act (MMA)), CMS identifies an appropriate existing code category
and/or establishes a new code category to describe the item that is the subject of a National
Coverage Determination (NCD).
Effective July 1, 2004, CMS’ procedures are as follows:
1. Assignment of an existing code: When CMS determines that an item is already identified
by an existing HCPCS code category, but was previously not covered, CMS will assign the
item to the existing code category and ensure that the coverage indicator assigned to the
code category accurately reflects Medicare policy regarding coverage for the item.
Section 731 of the MMA does not require that a new code category or a product specific
code be created for an item simply because a new coverage determination was made,
without regard to codes available in the existing code set.
2. Assignment of a New Code: When CMS determines that a new code category is
appropriate, CMS will make every effort to establish, publish, and implement the new code
at the time the final coverage determination is made.
3. Assignment of a Miscellaneous Code: Under certain circumstances, the assignment of an
item to a miscellaneous code may be necessary. A number of miscellaneous codes already
exist under various headings throughout the HCPCS Level II code set. When a new code is
appropriate, but the change cannot be implemented and incorporated into billing and claims
processing systems at the time the final NCD decision memorandum is released, an
unclassified code may be assigned in the interim, until a new code can be implemented, in
order to ensure that claims can be processed for the item. The timing of implementation of
new codes relative to the date of the coverage determination depends on a variety of
factors, some of which are not within the control of the code set maintainers. One such
example is when the timing of the coverage determination is such that the publication
deadline for the next update is missed.
REQUESTING A REVISION TO THE HCPCS LEVEL II CODES
Anyone may submit a request for modifying the HCPCS Level II national code set. CMS’ HCPCS
Level II application and instructions can be can be accessed at:
https://mearis.cms.gov/public/home 1. As part of the application, the applicant should also submit
any descriptive material, including the manufacturer's product literature and information that the
applicant thinks would be helpful in furthering CMS’ understanding of the medical features of the
item for which a coding revision is requested.
Applications that are received and determined by CMS to be complete by the deadline will be
considered for inclusion in that cycle. Applications received after the deadline will be considered
for the subsequent coding cycle. Applications received by the deadline that are determined to be
incomplete will also be declined and the applicant should submit a completed application in a
The electronic application intake system, Medicare Electronic Application Request Information SystemTM (MEARISTM), is
available for HCPCS Level II application submissions. Please note that all applicants have to create an account in MEARISTM
in order to complete and submit an application. Instructions on how to complete the application are also available in MEARIS
1

TM.

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subsequent coding cycle. CMS will make every effort to complete the review within the applicable
coding cycle for all timely and complete code applications. However, it should be understood that
on the rare occasion a particularly complex or multi-faceted decision requires additional evaluation
beyond the timeframe of the coding cycle, CMS maintains the flexibility at its discretion to
continue consideration of that application into the next coding cycle. Examples of circumstances
under which application consideration may be extended to the next coding cycle may include, but
are not limited to, coding considerations that require in-depth clinical or other research and
complicated claims adjudication scenarios.
There are three types of coding revisions to the HCPCS that can be requested:
1. Add a new code:
This could include requests to split an existing code category into its components or into
subcategories;
2. Revise an existing code:
When there is an existing code, a request can be made when a stakeholder believes that the
descriptor for the code needs to be revised to provide a better description of the category of
products represented by the code.
3. Discontinue an existing code:
When an existing code becomes obsolete or is duplicative of another code, a request can be
made to discontinue the code. This could include requests to combine existing codes.
The electronic application intake system, Medicare Electronic Application Request Information
SystemTM (MEARISTM), is available for HCPCS Level II application submissions. The OMBapproved HCPCS Level II Application form (CMS-10224, OMB-0938-1042) designed for
MEARISTM is similar to the prior paper application. The CMS HCPCS Level II Modification to Code
Set Form can be accessed at: https://mearis.cms.gov/public/home.
CMS only accepts HCPCS Level II applications submitted via MEARISTM. Applications submitted to
the HCPCS application mailbox are no longer considered. Within MEARISTM, there are several
resources to support applicants.
Evaluating HCPCS Level II Coding Applications
CMS applies the following criteria to determine when there is no demonstrated need for a
new or modified code or the need to remove a code:
1. When an existing code adequately describes the item in a coding request, no new or
modified code is established. An existing code adequately describes an item in a coding
request when the existing code describes items with the following:
•

Functions similar to the item in the coding request.
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•

No significant therapeutic distinctions from the item in the coding request.

2. When an existing code describes items that provide almost the same functionality with
only minor distinctions from the item in the coding request, the item in the coding
request may be grouped with that code and the code descriptor modified to reflect the
distinctions.
3. A code is not established for an item that is used only in the inpatient setting or for an
item that is not diagnostic or therapeutic in nature.
4. A new or modified code is not established for an item that is regulated by the FDA, unless
the FDA allows the item to be marketed. Documentation of FDA approval is required to
be submitted with the coding request application.
5. Applications for non-drug items that are not regulated by the FDA and also not yet
available in the U.S. market will be considered incomplete and will not be
processed.
6. The determination to remove a code is based on CMS’ consideration of whether a code is
obsolete (for example, items are no longer used, other more specific codes have been
added) or duplicative and no longer useful (for example, new codes are established that
better describe items identified by existing codes).
In developing its decisions, CMS uses the criteria mentioned above. Cost or pricing is not a factor.
HCPCS Level II Coding Cycles, Timelines, Deadlines, and Final Decisions
Beginning in 2020, CMS implemented shorter and more frequent coding cycles to further advance
its initiative to unleash innovation. Please note, beginning in 2023, HCPCS Level II application
submission deadlines will align with the first business day of each quarter (January, April, July and
October) for drug and biological products and first business day of January and July for non-drug
and non-biologicals.
Non-Drug and Non-Biological Coding Cycles: No less frequently than bi-annually
Coding Cycle 1 for applications for non-drug and non-biological items:
Application Deadline:
Publish Preliminary Decisions by:
Public Meeting:
Publication of Final Decisions:

11:59 PM First Business day of January
May-June
June (dates to be announced in Federal Register)
July-August

Coding Cycle 2 for applications for non-drug and non-biological items:
Application Deadline:
Publish Preliminary Decisions by:
Public Meeting:

11:59 PM First Business day of July
November
November-December (dates to be announced in
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Publication of Final Decisions:

Federal Register)
January (Following year)

HCPCS Level II Public Meetings:
In 2000, Congress passed the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection
Act of 2000 (BIPA), Public Law 106-554. Subtitle D, Section 531(b) of BIPA requires the Secretary
to have procedures that permit public consultation for coding and payment determinations for new
DME under Medicare Part B of title XVIII of the Social Security Act. Accordingly, CMS hosts biannual public meetings that provide a forum for interested parties to make oral presentations and/or
to submit written comments in response to preliminary HCPCS Level II coding for items and/or
services for which code applications have been submitted using the HCPCS coding revision process.
Coding requests for non-drug and non-biological products make up the majority of applications
addressed in these public meetings.
Agenda items for the meetings are published in advance of the public meeting on the HCPCS
website at https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSPublicMeetings.
The public meeting agendas include topic and summary of the coding request, CMS’ preliminary
HCPCS Level II coding recommendation, and the preliminary Medicare benefit category and
payment determinations, if applicable.
This public meeting forum provides an opportunity for the public to become aware of coding,
benefit category, and payment changes under consideration for non-drug and non-biological items,
as well as an opportunity for public input into final decisions. See: “Guidelines for Participation in
CMS’ HCPCS Public Meetings” on CMS’ HCPCS website
at https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSPublicMeetings.
Drugs and Biologicals Coding Cycles: No less frequently than quarterly
Coding Cycle 1 for applications for drugs and biologicals:
Application Deadline:
Publication of Final Decisions:

11:59 PM First Business day of January
April

Coding Cycle 2 for applications for drugs and biologicals:
Application Deadline:
11:59 PM First Business day of April
Publication of Final Decisions:
July
Coding Cycle 3 for applications for drugs and biologicals:
Application Deadline:
11:59 PM First Business day of July
Publication of Final Decisions:
October
Coding Cycle 4 for applications for drugs and biologicals:
Application Deadline:
Publication of Final Decisions:

11:59 PM First Business day of October
January (Following year)
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Changes to CMS’ HCPCS Level II Coding Procedures that Enable Quarterly Coding Cycles for
Drugs and Biologicals:
CMS’ delivery on its important goal and stakeholder requests to implement quarterly coding cycles
for drugs and biologicals necessitated procedural changes that balance the need to code more
quickly against the amount of time necessary to process applications, as described below.
The availability of final elements of FDA approval is critical to CMS decision making for drug
and biological codes, particularly where this shorter coding cycle makes CMS reliant upon having
complete application information at the time of the application deadline. Accordingly, in
implementing significantly shorter coding cycles, CMS has eliminated the 3-month deadline
extension for submission of FDA clearance documentation following the application deadline (as
previously offered within the annual coding cycle). Under the shorter coding cycles, all required
FDA documentation is due by the application deadline. Thus, under this process, the overall
timeframe between FDA approval and HCPCS Level II coding will generally be significantly
shorter than in the prior annual coding cycle.
In order to further achieve the additional time savings necessary to implement coding for the vast
majority of drugs and biologicals on a quarterly cycle, CMS will not be able to conduct public
meetings for coding decisions on drugs and biologicals, but will provide an opportunity for
applicants to resubmit the application in a subsequent quarterly coding cycle. This offers an
opportunity for applicants who are dissatisfied with CMS’ coding decisions in one quarterly cycle to
immediately reapply in the next or a subsequent quarterly cycle. Thus, the overall timeframe for
consideration of successive applications is generally still significantly shorter than the prior, annual
coding cycle. Although CMS previously included drug and biological code applications in its
HCPCS Public Meeting processes, we believe that the changes above are necessary to allow CMS to
provide coding on a quarterly cycle.
CMS reviews HCPCS Level II coding applications for 510(k) cleared non-drug/non-biological
products during our bi-annual coding cycles, and applications for human cells, tissues, and cellular
and tissue-based (HCT/P) products during our quarterly coding cycles. CMS will only review an
application that is complete, if submitted by the published deadline, will be reviewed. A complete
application for HCT/P should include the Food and Drug Administration’s (FDA) Tissue Reference
Group (TRG) recommendation letter that indicates how the product appears to be regulated by the
FDA. This information is necessary for CMS to determine how the product should be classified for
coding purposes.
CMS would also like to note that CMS may not be able to fully consider all of the requests that are
received for each coding cycle. Certain code set modification requests might necessitate more
extensive research to identify and analyze all of the data that are pertinent to evaluating the proposed
change to the HCPCS Level II code set and therefore, might be deferred to the next coding cycle.
Moreover, in the circumstance that extremely high volume of code set modification requests are
submitted for a coding cycle, CMS may not be able to review all the applications during that
particular coding cycle and may require additional time to formulate a final decision.

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Requests for Separate Meetings:
CMS staff may schedule meetings with an interested party, at the party’s request, as time permits
to discuss the application(s) for possible changes to the HCPCS Level II codes. These meetings
are held by teleconference.
These meetings are not related to the public meetings mandated by section 531(b) of BIPA; they
are also not decision-making meetings or CMS HCPCS Level II Application review meetings.
Final Decisions for All HCPCS Level II Applications:
CMS is responsible for making the final decisions pertaining to requests for additions, deletions,
and revisions to the HCPCS Level II codes. These decisions may include:
1. The request to establish a new national code has been approved.
2. The request to revise an existing national code has been approved.
3. The request to discontinue an existing national code has been approved.
4. A change to the national codes has been approved that reflects, completely or in part, the
coding request. Examples of circumstances under which a change to coding might
reflect, in part, the coding request include the addition of a single new code when the
incoming request was to establish a series of related codes (e.g., for different package
sizes); or addition of a new code that includes a dose descriptor reflecting the lowest
common denominator that could be billed in multiples, as per CMS’ longstanding coding
convention, when the incoming request specified a different dose descriptor.
5. The request for a new code has not been approved because the scope of the request
necessitates that additional consideration be given to the request before CMS reaches a
final decision.
6. The request for a new national code has not been approved because there already is an
existing code that describes the item or service.
7. The request for a code has not been approved because the item or service is not used
by health care providers for diagnostic or therapeutic purposes.
8. The request for a code has not been approved because the code requested is for
capital equipment.
9. The request for a code has not been approved because the item or service is an
integral part of another service and the code for that service includes the item.
10. The request for a revision to the language that describes the current code has not
been approved because it does not improve the code descriptor.
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11. The request for a new code has not been approved because the product is not primarily
medical in nature.
12. The request for a code has not been approved because the item or service is used
exclusively in the inpatient hospital setting.
13. The request for a code has not been approved because it is inappropriate for inclusion in
the HCPCS Level II code set and a request should be submitted independently to another
coding authority (e.g., AMA for CPT coding, ADA for CDT coding)
CMS will include the reasoning for reaching its decision, along with the decision.
Any applicant who disagrees with CMS’ final HCPCS coding decision may submit a new request
in a subsequent coding cycle. Applicants are encouraged to provide any new information that may
be helpful in explaining why CMS’ prior decision should be changed.
AVAILABILITY OF HCPCS LEVEL II UPDATES
As part of CMS’ ongoing efforts to improve transparency regarding HCPCS Level II coding
decisions and streamline our processes, CMS has implemented additional improvements to the
issuance of HCPCS Level II coding decisions. Beginning in 2020, consistent with implementing
shorter and more frequent HCPCS Level II coding cycles, CMS began releasing its decisions on all
coding actions on a quarterly basis in the same format as CMS previously announced its annual
decisions (see timeframes above). These actions are available on CMS’ website at
https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS
Each payer effectuates the changes to the code sets on its own timeframes. For Medicare, unless
otherwise announced or specified, the changes to the code sets will become effective as follows:
For Quarterly Cycle 1 Drug and Biological Code Applications:
Effective:
July
For Quarterly Cycle 2 Drug and Biological Code Applications and for Biannual Cycle 1 Non-Drug
and Non-Biological Code Applications:
Effective:
October
For Quarterly Cycle 3 Drug and Biological Code Applications:
Effective:
January (Following year)
For Quarterly Cycle 4 Drug and Biological Code Applications and for Biannual Cycle 2 Non-Drug
and Non-Biological Code Applications:
Effective:
April (Following year)
Along with quarterly releases, CMS also publishes narrative statements for the HCPCS Level II
coding decisions, which provide additional detailed information, including the topic and
background summary of every application; CMS’ preliminary HCPCS coding
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recommendations, where applicable; a summary of primary speaker comments at CMS’ HCPCS
Public Meetings, where applicable; and CMS’ final coding decisions and rationale.
In early 2019, CMS created an intuitive online search feature to identify links to current and prior
year’s publication of narrative summaries and spreadsheets providing HCPCS Level II application
and decision information. CMS also restored previously published information from prior years.
Previously, the information in the narrative summary has also been included in the HCPCS Level
II coding decision letters written by CMS and mailed to each individual applicant. To streamline
our notification processes, rather than issuing individual decision letters, CMS now refers
applicants and other stakeholders to the narrative summary and encourages stakeholders to
monitor CMS’ HCPCS General Information website
at https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index for updates.
CMS’ HCPCS General Information website also includes tools to assist stakeholders in locating
files and information regarding the most recent HCPCS Level II update, including a listing of
miscellaneous codes (referred to as “Not Otherwise Classified” (NOC)); HCPCS Public Meeting
Agendas, which list applications submitted in the current non-drug and non-biological coding
cycle; HCPCS Level II Coding Procedures; Guidelines for Participation in CMS’ HCPCS Public
Meeting; and notice of CMS’ decisions to discontinue HCPCS codes. Electronic updates and
instructions that include an updated list of codes and identify which codes have been added,
revised, or deleted are sent by CMS to Medicare contractors and state Medicaid agencies.
Rev. December, 2022

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