Quick Tool: Find Valid HCPCS for Drug Reporting under CR 8358

Since the implementation of CR 8358 in April 2014, CGS has identified several claims being delayed due to non-valid HCPCS. Save this quick reference to the 2015 list of valid HCPCS from the CMS website and review theses reminders to help eliminate HCPCS errors. 



From the CGS website: 

To avoid unnecessary processing delays, we want to remind hospice providers about the importance of reporting only valid HCPCS for drugs. Below are some key points to help ensure valid HCPCS reporting of drugs:

HCPCS that begin with an “S” (ex. S5502) are private payer codes, and are not valid for Medicare use. These HCPCS should not be reported on Medicare claims unless a valid HCPCS is determined.

HCPCS for saline solutions and dextrose should not be reported. These codes include, but are not limited to, J7030, J7040, J7042, J7050, and J7060.

CGS has also identified the importance of reporting the HCPCS with a valid revenue code. CGS advises:

HCPCS codes for drugs should only be reported with a 0636 revenue code (Injectable drug) or 0294 revenue code (Drug administered via infusion pump).

CGS has identified some instances where a HCPCS code was reported using revenue code 0250. Revenue code 0250 is to report non-injectable drugs, and should only be reported with a National Drug Code (NDC); not a HCPCS code. If a claim includes a HCPCS on a 0250 revenue code line, it will be returned to the provider (RTPd) for correction.

We reccomd reviewing the article here, and the CGS Hospice Prescription Drug Reporting Table