How are HCPCS codes updated annually?

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HCPCS codes are updated annually through a structured process managed by the Centers for Medicare & Medicaid Services (CMS) to reflect changes in medical technology, supplies, and services.

1. Two Levels of HCPCS Codes

• Level I: CPT codes (managed by the AMA)

• Level II: Alphanumeric codes (A-Z + 4 digits) for medical supplies, equipment, and drugs (managed by CMS)

2. Update Process for Level II Codes

a. Public Code Requests

Anyone—manufacturers, providers, or payers—can submit requests for new codes, revisions, or deletions. These are typically due in the first quarter of the year.

b. CMS Public Meetings

CMS hosts public meetings where stakeholders can present and discuss proposed code changes, especially for drugs and DME items.

c. CMS Review and Decision

CMS reviews clinical evidence, pricing data, and public input. Decisions are based on medical necessity, usage, and FDA approval status.

d. Publication of Updates

Final changes are published in HCPCS Update files around November, and the new codes become effective January 1 of the following year.

3. Quarterly Drug Code Updates

Drug-related HCPCS codes (e.g., J-codes) may also be updated quarterly to reflect new FDA approvals or changes in drug availability.

Why This Matters

Annual updates ensure HCPCS codes stay current with medical innovations, support accurate billing, and align with regulatory requirements for Medicare and other payers.

Read More

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