November 2018

CMS Releases 2019 HCPCS Code Changes

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.

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