Centers for Medicare & Medicaid Services Special Open Door Forum: Changes to Level II Healthcare Common Procedure Coding System (HCPCS) Coding and Application Submission Procedures for 2019

Centers for Medicare & Medicaid Services

Special Open Door Forum:

Changes to Level II Healthcare Common Procedure Coding System (HCPCS)

Coding and Application Submission Procedures for 2019

Tuesday, December 18, 2018

1:30 pm-2:30 pm Eastern Time

Conference Call On

CMS will host a Special Open Door Forum (ODF) to announce changes to CMS’ Level II HCPCS Coding Procedures and HCPCS Code Application Procedures effective in the 2019-2020 HCPCS coding cycle, and to allow all stakeholders of these processes, and other interested parties, to ask questions regarding our process changes, as detailed on CMS’ HCPCS web site at http://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html  

CMS is interested in adopting changes to the HCPCS process that facilitate the adoption of new technologies while balancing the burden on payers and providers and considers program needs. As CMS continues to examine this program area, we are making the following changes to the HCPCS coding process for the calendar year 2019 cycle:

1. Clarifying and updating web-site guidance associated with the application process to promote transparency and clarity: See HCPCS Code Application Form and Instructions 2020 @   https://www.CMS.gov/Medicare/Coding/MedHCPCSGenInfo/Application_Form_and_Instructions.html
2. Advancing a new electronic application process and initiating the first public beta test of this process with a limited number of stakeholders for the 2019 cycle: See announcement of CMS’ public beta test under “What’s New” on CMS’ General Info site @https://www.CMS.gov/Medicare/Coding/MedHCPCSGeninfo/index.html 
3. Eliminating the three percent (of market) volume criteria as a coding criteria for non-drug items. CMS will continue to collect marketing data on the application, to support the establishment of a new code.See “HCPCS Decision Tree”@ https://www.CMS.gov/Medicare/Coding/MedHCPCSGenInfo/Downloads/HCPCS_Decision_Tree_and_Definitions.pdfSee “Healthcare Common Procedure Coding System (HCPCS) Level II Coding Procedures” @https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSCODINGPROCESS.html 
4. Providing more detailed responses to applications in order to provide for greater transparency and to assist the public in understanding CMS’ decision making.  
5. Providing for greater transparency and public input by providing for remote participation in HCPCS Public Meetings. To be announced prior to 2019 HCPCS Public Meetings.
6. Increasing transparency by including an archive of past years’ files/decisions on the CMS.gov HCPCS website (instead of our current process of replacing the past year when a new one is available). This will provide a research archive for potential applicants and stakeholders. See: HCPCS Coding Decision Download files for the current and past HCPCS coding cycles @https://www.CMS.gov/Medicare/Coding/MedHCPCSGenInfo/CMS-Level-II-Coding-Decisions.html

We look forward to your participation.

Special Open Door Participation Instructions:

Participant Dial-In Number: 1-800-837-1935

Conference ID #: 3073759

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

A transcript and audio recording of this Special ODF will be posted to the Podcast and Transcripts website at https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.html for downloading.            

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/OpenDoorForums/.

Thank you for your interest in CMS Open Door Forums.