Considerations

Before Applying for a New Code:

Prior to applying for a new code, it may be useful to determine which code set, if any, the product or service is suited to, who the code set maintainer is, and whether the product, procedure, or service is described in the existing code set. Code sets maintained by CMS and the CDC are updated regularly, and files are made publicly available on their respective websites for download and distribution. A few considerations for common coding applications are listed below:

• Whether the setting of use is suitable for HCPCS Level II coding;
• Whether the coding request is best suited for CPT® coding;
• Whether an existing HCPCS Level II code already describes the product; and
• Whether the product in the application is typically packaged into payment for the procedure under a CPT® code and is not typically paid separately by Medicare or other payers.

For more information, visit the following webpages:

• ICD-10-PCS
• ICD-10-CM
• CPT®-4/HCPCS Level I
• HCPCS Level II (other than Pass-Through and CDT-4 codes)
• HCPCS Level II Device Pass-Through codes
• HCPCS Level II Drugs and Biological Pass-Through codes