July 2017 OPPS Update

on Tuesday, 20 June 2017. All News Items | Outpatient Services | Coding

Codes, Codes and More Codes

The main news from the July 2017 OPPS Update is codes, codes, and more codes. There were new Category III codes, new proprietary laboratory analyses codes, new separately payable procedure codes, new device intensive procedures, new… well, you get the picture. See the table below for a listing of all the new codes and other code changes.

July 2017 OPPS Code Updates
CPT CodeLong DescriptorOPPS Status IndicatorEffective DateDescription of Change
0469T Retinal polarization scan, ocular screening with on-site automated results, bilateral E1
(not paid by Medicare on outpatient claim)
July 1, 2017 New Category III CPT code for Medicare
0470T Optical coherence tomography (OCT) for microstructural and morphological imaging of skin, image acquisition, interpretation, and report; first lesion M
(not paid under OPPS)
July 1, 2017 New Category III CPT code for Medicare
0471T Optical coherence tomography (OCT) for microstructural and morphological imaging of skin, image acquisition, interpretation, and report; each additional lesion (List separately in addition to code for primary procedure) N
(payment packaged into payment for other services)
July 1, 2017 New Category III CPT code for Medicare
0472T Device evaluation, interrogation, and initial programming of intra-ocular retinal electrode array (eg, retinal prosthesis), in person, with iterative adjustment of the implantable device to test functionality, select optimal permanent programmed values with analysis, including visual training, with review and report by a qualified health care professional Q1
(packaged if on claim with services with an SI of "S", "T", or "V")
July 1, 2017 New Category III CPT code for Medicare
0473T Device evaluation and interrogation of intraocular retinal electrode array (eg, retinal prosthesis), in person, including reprogramming and visual training, when performed, with review and report by a qualified health care professional Q1
(packaged if on claim with services with an SI of "S", "T", or "V")
July 1, 2017 New Category III CPT code for Medicare
0474T Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space J1
(comprehensive APC; payment for most other services on claim packaged into payment of primary J1 service)
July 1, 2017 New Category III CPT code for Medicare; also new Device Intensive Procedure
0475T Recording of fetal magnetic cardiac signal using at least 3 channels; patient recording and storage, data scanning with signal extraction, technical analysis and result, as well as supervision, review, and interpretation of report by a physician or other qualified health care professional M
(not paid under OPPS)
July 1, 2017 New Category III CPT code for Medicare
0476T Recording of fetal magnetic cardiac signal using at least 3 channels; patient recording, data scanning, with raw electronic signal transfer of data and storage Q1
(packaged if on claim with services with an SI of "S", "T", or "V")
July 1, 2017 New Category III CPT code for Medicare
0477T Recording of fetal magnetic cardiac signal using at least 3 channels; signal extraction, technical analysis, and result Q1
(packaged if on claim with services with an SI of "S", "T", or "V")
July 1, 2017 New Category III CPT code for Medicare
0478T Recording of fetal magnetic cardiac signal using at least 3 channels; review, interpretation, report by physician or other qualified health care professional M
(not paid under OPPS)
July 1, 2017 New Category III CPT code for Medicare
0004U Infectious disease (bacterial), DNA, 27 resistance genes, PCR amplification and probe hybridization in microarray format (molecular detection and identification of AmpC, carbapenemase and ESBL coding genes), bacterial culture colonies, report of genes detected or not detected, per isolate A
(Paid under fee schedule other than OPPS; Clinical Lab Fee Schedule (CLFS) for this test)
May 1, 2017 New Proprietary Laboratory Analyses (PLA) CPT Code
0005U Oncology (prostate) gene expression profile by real-time RT-PCR of 3 genes (ERG, PCA3, and SPDEF), urine, algorithm reported as risk score Q4
(Payment packaged unless only lab tests on claim)
May 1, 2017 New Proprietary Laboratory Analyses (PLA) CPT Code
C9745 Nasal endoscopy, surgical; balloon dilation of eustachian tube J1
(comprehensive APC; payment for most other services on claim packaged into payment of primary J1 service)
July 1, 2017 New Separately Payable Procedure Code; also new Device Intensive Procedure
C9746 Transperineal implantation of permanent adjustable balloon continence device, with cystourethroscopy, when performed and/or fluoroscopy, when performed J1
(comprehensive APC; payment for most other services on claim packaged into payment of primary J1 service)
July 1, 2017 New Separately Payable Procedure Code; also new Device Intensive Procedure
C9747 Ablation of prostate, transrectal, high intensity focused ultrasound (HIFU) J1
(comprehensive APC; payment for most other services on claim packaged into payment of primary J1 service)
July 1, 2017 New Separately Payable Procedure Code
Q9987 Pathogen(s) test for platelets S
(Paid under OPPS)
July 1, 2017 Replaces part of HCPCS code P9072
Q9988 Platelets, pathogen reduced, each unit R
(Blood product; paid under OPPS)
July 1, 2017 Replaces part of HCPCS code P9072
C9489 Injection, nusinersen, 0.1 mg G
(Pass-through drug; paid under OPPS)
July 1, 2017 Granted Pass-through status
C9490 Injection, bezlotoxumab, 10 mg G
(Pass-through drug; paid under OPPS)
July 1, 2017 Granted Pass-through status
Q9984 Levonorgestrel-releasing intrauterine contraceptive system (Kyleena), 19.5 mg E1
(not paid by Medicare on outpatient claim)
July 1, 2017 New HCPCS Code
Q9985 Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg N
(payment packaged into payment for other services)
July 1, 2017 New HCPCS Code
Q9986 Injection, hydroxyprogesterone caproate (Makena), 10 mg K
(Nonpass-through drug; paid under OPPS)
July 1, 2017 New HCPCS Code
90682 Influenza virus vaccine, quadrivalent (riv4), derived from recombinant dna, hemagglutinin (ha) protein only, preservative and antibiotic free, for intramuscular use L
(Paid at reasonable cost)
July 1, 2017 SI change from E1 to L
J1725 Injection, hydroxyprogesterone caproate, 1 mg E1
(not paid by Medicare on outpatient claim)
July 1, 2017 SI change from K to E1
Q9989 Ustekinumab, for Intravenous Injection, 1 mg G
(Pass-through drug; paid under OPPS)
July 1, 2017 Replaces HCPCS code C9487
G0404 Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the Initial Preventive Physical Examination (IPPE) S
(Paid under OPPS)
January 1, 2017 Correction of inappropriate waiver of deductible and co-pay (Coinsurance and deductible DO APPLY)

 

Article by Debbie Rubio

Debbie Rubio, BS, MT (ASCP), is the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc. Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system. In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers. You may contact Debbie at This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.

green-iconWe are an environmentally conscious company, dedicated to living “green” both at work and as individuals.

Location

home-icon
1900 Twentieth Avenue South
Suite 220
Birmingham, AL 35209

Connect

phone
205-941-1105
phone
800-592-9639
email
This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 mhms