The Centers for Medicare and Medicaid Services (CMS) has released the new Healthcare Common Procedure Coding System (HCPCS) codes, effective for claims with a date of service on or after January 1, 2019. The following code changes are relevant to lower extremity care providers:
New Codes
A5514: For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each
M1045: Functional status measurement with score was obtained utilizing the oxford knee score (oks) patient reported outcome tool within 3 months preoperatively and at 1 year (9 to 15 months) postoperatively
M1046: Functional status measurement with score was not obtained utilizing the oxford knee score (oks) patient reported outcome tool within 3 months preoperatively and at 1 year (9 to 15 months) postoperatively
M1047: Functional status was measured by the oxford knee score (oks) patient reported outcome tool within 3 months preoperatively and at 1 year (9 to 15 months) postoperatively
M1053: Leg pain was measured by the visual analog scale (vas) within 3 months preoperatively and at 1 year (9 to 15 months) postoperatively
Change in Coverage
A5512: For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fahrenheit or higher, total contact with patient’s foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16-inch material of shore a 40 durometer (or higher), prefabricated, each
Change in Code Descriptor and Coverage
A5513: For diabetics only, multiple density insert, custom molded from model of patient’s foot, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each
Discontinued Code
K0903 (a temporary code that has been active since April 1, 2018, and will be cross walked to the new code A5514): For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each
Long Description Changes
G8647–G8650: Related to risk-adjusted functional status change residual score for the knee impairment
G8651–G8654: Related to risk-adjusted functional status change residual score for the hip impairment
G8655–G8658: Related to risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment
To access the complete list, visit www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html and click on the link to the 2019 Alpha-Numeric HCPCS File.