CMS HCPCS Level II Codes Effective January 1, 2013

November 27, 2012

The 2013 Healthcare Common Procedure Coding System (HCPCS) electronic file has been posted with updated file information on the Centers for Medicare and Medicaid Services (CMS) web site.  There is one new radiopharmaceutical code effective January 1, 2013 and is listed in the table below. There were no other HCPCS Level II code revisions important to nuclear medicine procedures for CY 2013.



Note:  Amyvid™ is a radiopharmaceutical indicated for Positron Emission Tomography (PET) imaging of the brain to estimate beta-amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for Alzheimer’s Disease (AD) and other causes of cognitive decline.

A9586 is assigned a status indicator “E” in hospital Outpatient Prospective Payment System (OPPS) meaning it is non-covered by statutory exclusion. Effective January 1, 2013 use A9586 for all settings, i.e., hospital outpatient, physician office, independent diagnostic imaging facilities (IDTFs) and all third party payers for claims with dates of service on or after January 1, 2013.

For more details see the SNM Practice Management Coding Corner article on Amyvid.

For additional HCPCS Level II Code additions, revisions and deletions, please download the 2013 Alpha-Numeric HCPCS File on the CMS web site.