HCPCS January 2023 Updates: New, Revised, and Deprecated HCPCS Codes and Modifiers (2023)

FAQs

What are the deleted HCPCS codes for 2023? ›

Deleted CPT® 2023 Codes

Under the Hospital Observation Services heading, observation care discharge services code 99217, initial observation care codes 99218-99220, and subsequent observation care codes 99224-99226 are deleted.

CMS is finalizing its proposal, with modification, to remove procedure codes from the IPO list beginning in CY 2023. CMS is not finalizing its proposal to remove CTP 16036 from the IPO list. However, CMS is removing 2 additional CPT codes that had not been included in the proposed rule: CPT 47550 and 21255.

As with CPT codes, we always want to use modifiers for functionality first, and information second. That is, you'll want to list the HCPCS modifier that directly affects reimbursement first.

In total, next year's CPT code set will see 393 editorial changes, including 225 new codes, 75 deletions, and 93 revisions. The code set will go into effect on Jan. 1, 2023. Providers can import the updated code set into their existing IT systems using the downloadable CPT 2023 Data File.

The new updates to the ICD-10-CM code system for 2023 include 1176 new billable healthcare codes for areas such as social determinants of health (SDoH), dementia, maternal care, and pregnancy.

The KCC Model will have more than 8,398 participating health care providers and organizations and 249,983 beneficiaries in 2023, an 87% increase in the number of providers and organizations, a 62% increase in the number of beneficiaries from 2022, and the second cohort of the KCC Model increases the geographic reach of ...

HCPCS G0316, Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, ...

Three new codes (81449, 81451, and 81456) describe targeted genomic sequence analyses. Four new codes (87468, 87469, 87478, 87484) describe various infectious agent detections using DNA or RNA. One new code (81418) has been added for drug metabolism analysis using a genomic sequence.

When Must new CPT codes be used? ›

CPT codes implementation schedule

As the designated standard for the electronic reporting of physician and other health care professional services under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), CPT codes are updated annually and effective for use on Jan. 1 of each year.

The current version is the CPT 2023. The CPT code set is also known as the HCPCS Level I codes for Medicare/Medicaid purposes.

Medicare will automatically reject claims that have the –GX modifier applied to any covered charges. Modifier –GX can be combined with modifiers –GY and –TS (follow up service) but will be rejected if submitted with the following modifiers: EY, GA, GL, GZ, KB, QL, TQ.

HCPCS codes are for basic healthcare services like medical devices, medical supplies, etc. These codes provide a standardized description of the services. CPT codes are for services like surgeries, diagnostic tests, evaluation and management services (E&M), etc.

A medical coding modifier is two characters (letters or numbers) appended to a CPT^® or HCPCS Level II code. The modifier provides additional information about the medical procedure, service, or supply involved without changing the meaning of the code.

Effective January 1, 2023, this level of care requires high complexity MDM or 50 minutes before, during and after the visit on the date of the encounter.

The complete HCPCS file is updated and released quarterly to the Medicare contractors. The file contains existing, new, revised and discontinued HCPCS codes for the October 2022 quarter. Contractors must download the file via the CMS mainframe in September 2022.

CPT® 2023 Professional Edition is an AMA-authored resource to help healthcare professionals correctly report and bill medical procedures and services. Healthcare professionals want accurate reimbursement. Payers want efficient claims processing.

Certain services are never considered for payment by Medicare. These include preventive examinations represented by CPT codes 99381-99397. Medicare only covers three immunizations (influenza, pneumonia, and hepatitis B) as prophylactic physician services.

Level I is comprised of Current Procedural Terminology^® codes (HCPT). HCPT codes consist of five numeric digits. For more information about HCPT, see the HCPT source synopsis. Level II HCPCS codes identify products, supplies, and services not included in CPT.

What are the two main coding systems? ›

The medical coding systems currently used in the United States are ICD-10-CM/PCS and HCPCS (Level I CPT codes and Level II National Codes).

There are 1176 new billable healthcare codes in the ICD-10-CM code system for 2023, covering dementia, social determinants of health (SDoH), head injury and therapy for prolonged drug use, pregnancy, endometriosis, and maternal care.

287 codes were deleted from the 2023 ICD-10-CM code set, effective October 1, 2022. Displaying codes 1-100 of 287: B37.

*Office visits are not billable as split/shared services. Beginning January 1, 2023, the physician or practitioner who spends more than half the total time (the substantive portion) will bill for the primary E/M visit and the prolonged service codes when the service is furnished as a split/shared visit.

This final rule with comment period includes payment adjustments to hospitals under the IPPS and OPPS for the additional resource costs they incur to acquire domestic NIOSH-approved surgical N95 respirators. The payment adjustments will commence for cost reporting periods beginning on or after January 1, 2023.

The Final Rate Announcement (formerly known as “the Call Letter”) finalized a noteworthy 8.5% average revenue increase, which is more than double the 4% increase in 2022 and reflects CMS' commitment to the stability of the MA program and the health of the more than 28 million beneficiaries enrolled in the program.

Each year new, changed and deleted codes are released and become effective on October 1st for ICD-10-CM/PCS and January 1st for CPT and HCPCS code sets. Also code updates are issued each quarter throughout the year. Stay Compliant! There are 1000s of changes which may affect the codes that you are currently using.

Gray Code is one of the most important codes. It is a non-weighted code which belongs to a class of codes called minimum change codes.

What does HCPCS stand for? ›

The Healthcare Common procedure Coding System (HCPCS) is divided into two principal subsystems, referred to as level I and level II of the HCPCS.

Categories of CPT Modifiers

The most widely used CPTs in an office setting are the E/M Codes 99201-99215; however, very few modifiers can be associated with these services. CPT modifier 25 can only be used for E/M CPTs, and under certain circumstances modifier 52 can be used as well.

Initially, use of the codes was voluntary, but with the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) use of the HCPCS for transactions involving health care information became mandatory.

Identical services being repeated should be submitted using CPT modifier 76, 77, or 91. CPT Modifier 76: 'Repeat procedure by same physician: The physician may need to indicate that a service was repeated the same day subsequent to the original service.

It is possible to bill 2 CPT codes during the same 15-minute time period.

There are coding and guideline changes in every section of the CPT® 2023 code set, except anesthesia. The most significant changes are to the evaluation and management (E/M), percutaneous pulmonary artery revascularization, hernia repairs, lab and pathology, and COVID-19 vaccination codes.

The AMA has released its Current Procedural Terminology (CPT®) code set update for 2023 which encompass 393 editorial changes, 225 new codes, 75 deleted codes and 93 revised codes. The new CPT code set will go into effect on January 1, 2023.

Answer: Protected and Private modifiers are not used for a class.

Types of Modifiers:

Level I modifiers or CPT Modifiers comprises of two numeric digits and is copyrighted & updated annually by the American Medical Association (AMA) Level II Modifiers. Level II modifiers or HCPCS modifiers can be made of either Alphabets or Alphanumeric.

Which modifier is not approved for hospital outpatient use? ›

Modifier -53 is used to indicate discontinuation of physician services and is not approved for use for outpatient hospital services.

Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items.

Yes you may append modifier 59 to an add on code.

different shoulders, modifiers RT and LT should be used, not modifier 59. LT and RT have not effect on the actual processing of the claim for payment, because they are informational.

Never use both modifier 51 and 59 on a single procedure code. If there is a second location procedure (such as a HCPCS code for right or left), use the CPT^® modifier first.

The AMA has released its Current Procedural Terminology (CPT®) code set update for 2023 which encompass 393 editorial changes, 225 new codes, 75 deleted codes and 93 revised codes. The new CPT code set will go into effect on January 1, 2023.

(CPT codes 92585 and 92586 were deleted on January 1, 2021. CPT code 92564 was deleted on January 1, 2022.) 2. Speech language pathologists may perform services coded as CPT codes 92507, 92508, or 92526.

Based on the CPT changes, code 99201 is no longer valid for dates of service on and after January 1, 2021, as clinicians may choose the E/M visits level based on either medical decision making or time, both CPT code 99201 and 99202 previously require straightforward medical decision making, therefore the decision was ...

Effective Jan. 1, 2023, hospital observation codes 99217-99220 and 99224-99226 are deleted. These services are merged into the existing hospital inpatient services codes 99221-99223, 99231-99233, and 99238-99239, and the subsection is renamed Inpatient Hospital or Observation Care.

CPT modifier 53 indicates procedure discontinued by physician or other qualified health care professional and may not be reported by facilities. Reimbursement for discontinued procedure with modifier 53 is 25% of the allowable amount.

What are 2 new CPT codes in 2023 that describe remote or indirect patient care? ›

Additional new codes describe the respiratory syncytial vaccine (90678), orthoptic training (92066), quantitative pupillometry (95919), and remote therapeutic monitoring for cognitive behavioral therapy (98978).

Modifier 59 is not going away and will continue to be a valid modifier, according to Medicare. However, modifier 59 should NOT be used when a more appropriate modifier, like a XE, XP, XS or XU modifier, is available. Certain codes that are prone to incorrect billing may also require one of the new modifiers.

There is no reason to use a modifier 22 on an unlisted code because unlisted codes are given a value based on the work that is documented in the record for that particular encounter. Modifier 22 indicates that a given procedure required more physician work or time than that which is usually required for that procedure.

For example, you would not apply modifier 25 to each 99202 CPT code. However, if you saw a new patient, completed the services rendered as appropriate to bill a 99202 E&M, and performed an injection on the same day, you would apply a 25 modifier on the new patient E&M service.

In 2021, history and exam will no longer be used to select an E&M service, but still must be performed in order to report CPT ® codes 99202-99215. In 2021, E&M code selection will be based on either 1) The level of medical decision making (MDM) OR 2) The time performing the service on the day of the encounter.

For scratch, puncture, and prick testing (code 95004) and a single intradermal test (code 95024), both types of testing may be reported when testing involves the same allergen and is performed on the same day. Hence, there is no need for modifier 59 if allregic testing through both the techniques are performed.

No, for 2023, the codes for reporting observation care services (99217–99220) will be deleted and observation care services will be merged into the codes previously used to report only inpatient care services (99221–99233, 99238–99239).