Deleted HCPCS Codes/Modifiers

20.4 - Deleted HCPCS Codes/Modifiers (Rev. 10320, Issued: 08-28-2020, Effective: 12-01-2020, Implementation: 12-01-2020) Claims for services in a prior year are reported and processed using the HCPCS codes/modifiers in effect during that year. For example, a claim for a service furnished in November 2019 but received by an A/B MAC (A), (B), or (HHH), or DME MAC in 2020, should contain codes/modifiers valid in 2019 and is processed using the prior year’s pricing files. HCPCS codes (Level I CPT-4 and Level II alpha-numeric) are updated on a quarterly basis. Each quarter (January, April, July and October), CMS releases the HCPCS file to A/B MACs (A), (B), (HHH), and DME MACs. The HCPCS file contains the CPT-4 and the alpha-numeric updates. All MACs are notified of the release date via a one-time notification instruction. The file contains new, deleted, and revised HCPCS codes which are effective for the upcoming quarter. The Health Insurance Portability and Accountability Act (HIPAA) requires that medical code sets must be date of service compliant. Providers can purchase the American Medical Association’s CPT-4 coding book that is published each October that contains new, revised, and discontinued CPT-4 codes for the upcoming year. In addition, CMS posts on its Web site the alpha-numeric HCPCS file. Providers are encouraged to access CMS web site to see the new, revised, and discontinued alpha-numeric codes. The CMS web site to view the HCPCS update is https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html. A/B MACs (B) and DME MACs must reject services submitted with discontinued HCPCS codes. A/B MACs (A) and (HHH) must return to the provider (RTP) claims containing deleted codes. See the Medicare Claims Processing Manual, Chapter 22, “Remittance Notices to Providers.”