Take Note of These April 1 HCPCS Level II Code Changes
Learn about the HCPCS Level II quarterly update. The Centers for Medicare & Medicaid Services (CMS) have announced their quarterly update to the HCPCS Level II codes. Changes include new codes, procedure status changes, short descriptor code revisions, payment policy indicator changes, and new supply codes. Here’s what you need to know to ensure accurate coding and proper claims payment after the changes become effective on April 1. Add These Codes to Your Medicare Billing The April update includes 36 new HCPCS Level II codes. Here they are, along with their short descriptors and their status indicators (A=Active, E=Excluded from MPFS, C=Carrier/MAC-priced code, and X=Statutory exclusion): Understand These Procedure Status Changes The co-surgery indicator for CPT® code 37215 (Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection ) is changing to “1,” meaning co-surgeons may be paid if you have the supporting documentation required to establish medical necessity. Change This Short Descriptor Code Just one code’s short descriptor is being revised. The short descriptor change for HCPCS Level II code J0174 is as follows: Old: Injection, lecanemab-irmb, 1 mg New: Lecanemab-irmb, for iv inj Go Back to Process These Retroactive Changes Some of the changes in the April update are retroactively effective Jan. 1, 2026. Those changes are: There are also technical corrections to the malpractice relative value units for the following CPT® codes: 21610, 22319, 22554, 26562, 33269, 33464, 33983, 35221, 37660, 44322, 58290, 60271, 61320, and 64804. Medicare Administrative Contractors (MACs) will be sending participating providers a notice of the April 2026 update to the HCPCS Level II code set. But they will not automatically adjust claims containing outdated information. This means medical coders and billers need to be on the lookout for coding and payment changes in the update and act accordingly. MACs have until April 6 to implement these changes. See CMS Transmittal 13648 for complete instructions sent to MACs. And Don’t Forget These Additional April Updates The Centers for Medicare & Medicaid Services (CMS) has also released April 2026 updates to the Clinical Laboratory Fee Schedule (CLFS) and the Vaccine Administration National Fee Schedule (VANFS). Effective April 1, HCPCS Level II code Q0238 (listed above) describes TYENNE® (tocilizumab-aazg) to treat COVID-19. The associated intravenous administrative codes are M0233 and M0234 (also listed above). See CMS MLN Matters article MM14390 for details. See CMS Transmittal 13639, Change Request 14371 for the list of 17 new proprietary laboratory analysis (PLA) codes (0614U-0630U) that go into effect April 1. Renee Dustman, Managing Editor, Content & Editorial, AAPC
(A version of this article first appeared on the AAPC Knowledge Center blog)
