| March 27, 2025 Joint DME MAC and PDAC Publication The following tables identify changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for April 2025. The tables contain only HCPCS codes applicable to items within Medicare DME MAC jurisdiction. There may be other HCPCS code changes for items under the jurisdiction of other Medicare contractors. Consult those contractors for information regarding HCPCS codes within their areas of responsibility. All HCPCS code changes are effective for claims with dates of service on or after April 1, 2025. Code Change Categories - Added Codes/Modifiers: Identifies newly created codes and modifiers. Listing of a code in the tables does not necessarily indicate coverage. Refer to the applicable Local Coverage Determination for information regarding Medicare reimbursement requirements.
- Discontinued Codes/Deleted Modifiers: Identifies codes and modifiers discontinued or deleted in the new cycle. These codes and modifiers continue to be valid for Medicare claims with dates of service either on or before March 31, 2025. There is no grace period for submission of a discontinued code/modifier for claims with dates of service after its effective end date. If there is a direct crosswalk for a discontinued/deleted code or modifier, the crosswalk code will be displayed in a table.
- Narrative Changes: Identifies changes in the narrative descriptor for an existing code or modifier.
Added Codes Ankle-Foot/Knee-Ankle-Foot Orthoses | Code | Narrative | | L1933 | ANKLE FOOT ORTHOSIS, RIGID ANTERIOR TIBIAL SECTION, TOTAL CARBON FIBER OR EQUAL MATERIAL, PREFABRICATED, OFF-THE-SHELF | | L1952 | ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE), PLASTIC OR OTHER MATERIAL, PREFABRICATED, OFF-THE-SHELF | Immunosuppressive Drugs | Code | Narrative | | J7521 | TACROLIMUS, GRANULES, ORAL SUSPENSION, 0.1 MG | Lower Limb Prostheses | Code | Narrative | | L5827 | ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, ELECTROMECHANICAL SWING AND STANCE PHASE CONTROL, WITH OR WITHOUT SHOCK ABSORPTION AND STANCE EXTENSION DAMPING | Wheelchair Options/Accessories | Code | Narrative | | E1032 | WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING HARDWARE USED WITH JOYSTICK OR OTHER DRIVE CONTROL INTERFACE | Wheelchair Seating | Code | Narrative | | E1022 | WHEELCHAIR TRANSPORTATION SECUREMENT SYSTEM, ANY TYPE INCLUDES ALL COMPONENTS AND ACCESSORIES | | E1023 | WHEELCHAIR TRANSIT SECUREMENT SYSTEM, INCLUDES ALL COMPONENTS AND ACCESSORIES | | E1033 | WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING HARDWARE FOR HEADREST, CUSHIONED, ANY TYPE | | E1034 | WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING HARDWARE FOR LATERAL TRUNK OR HIP SUPPORT, ANY TYPE | Miscellaneous | Code | Narrative | | A6515 | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, FULL LEG, EACH, CUSTOM | | A6516 | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, FOOT, EACH, CUSTOM | | A6517 | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, BELOW KNEE, EACH, CUSTOM | | A6518 | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, ARM, EACH, CUSTOM | | A6519 | GRADIENT COMPRESSION GARMENT, NOT OTHERWISE SPECIFIED, FOR NIGHTTIME USE, EACH | | A6611 | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, ABOVE KNEE, EACH, CUSTOM | | E0201 | PENILE CONTRACTURE DEVICE, MANUAL, GREATER THAN 3 LBS TRACTION FORCE | | E1832 | STATIC PROGRESSIVE STRETCH FINGER DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES | | J0281 | INJECTION, AMINOCAPROIC ACID, 1 GRAM | | J1072 | INJECTION, TESTOSTERONE CYPIONATE (AZMIRO), 1 MG | | J1271 | INJECTION, DOXYCYCLINE HYCLATE, 1 MG | | J1299 | INJECTION, ECULIZUMAB, 2 MG | | J1308 | INJECTION, FAMOTIDINE, 0.25 MG | | J1808 | INJECTION, FOLIC ACID, 0.1 MG | | J1938 | INJECTION, FUROSEMIDE, 1 MG | | J2351 | INJECTION, OCRELIZUMAB, 1 MG AND HYALURONIDASE-OCSQ | | J2428 | INJECTION, PALIPERIDONE PALMITATE EXTENDED RELEASE (ERZOFRI), 1 MG | | J2804 | INJECTION, RIFAMPIN, 1 MG | | J2865 | INJECTION, SULFAMETHOXAZOLE 5 MG AND TRIMETHOPRIM 1 MG | | J9024 | INJECTION, ATEZOLIZUMAB, 5 MG AND HYALURONIDASE-TQJS | | J9038 | INJECTION, AXATILIMAB-CSFR, 0.1 MG | | J9054 | INJECTION, BORTEZOMIB (BORUZU), 0.1 MG | | J9161 | INJECTION, DENILEUKIN DIFTITOX-CXDL, 1 MCG | | L0720 | CERVICAL-THORACIC-LUMBAR-SACRAL-ORTHOSES (CTLSO), ANTERIOR-POSTERIOR-LATERAL CONTROL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE | | L6028 | PARTIAL HAND INCLUDING FINGERS, FLEXIBLE OR NON-FLEXIBLE INTERFACE, ENDOSKELETAL SYSTEM, MOLDED TO PATIENT MODEL, FOR USE WITHOUT EXTERNAL POWER, NOT INCLUDING INSERTS DESCRIBED BY L6692 | | L6029 | UPPER EXTREMITY ADDITION, TEST SOCKET/INTERFACE, PARTIAL HAND INCLUDING FINGERS | | L6030 | UPPER EXTREMITY ADDITION, EXTERNAL FRAME, PARTIAL HAND INCLUDING FINGERS | | L6031 | REPLACEMENT SOCKET/INTERFACE, PARTIAL HAND INCLUDING FINGERS, MOLDED TO PATIENT MODEL, FOR USE WITH OR WITHOUT EXTERNAL POWER | | L6032 | ADDITION TO UPPER EXTREMITY PROSTHESIS, PARTIAL HAND INCLUDING FINGERS, ULTRALIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL) | | L6033 | ADDITION TO UPPER EXTREMITY PROSTHESIS, PARTIAL HAND INCLUDING FINGERS, ACRYLIC MATERIAL | | L6037 | IMMEDIATE POST-SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING, INCLUDING FITTING ALIGNMENT AND SUSPENSION OF COMPONENTS, AND ONE CAST CHANGE, PARTIAL HAND INCLUDING FINGERS | | L6700 | UPPER EXTREMITY ADDITION, EXTERNAL POWERED FEATURE, MYOELECTRONIC CONTROL MODULE, ADDITIONAL EMG INPUTS, PATTERN-RECOGNITION DECODING INTENT MOVEMENT | | L7406 | ADDITION TO UPPER EXTREMITY, USER ADJUSTABLE, MECHANICAL, RESIDUAL LIMB VOLUME MANAGEMENT SYSTEM | | Q5147 | INJECTION, AFLIBERCEPT-AYYH (PAVBLU), BIOSIMILAR, 1 MG | | Q5148 | INJECTION, FILGRASTIM-TXID (NYPOZI), BIOSIMILAR, 1 MICROGRAM | | Q5149 | INJECTION, AFLIBERCEPT-ABZV (ENZEEVU), BIOSIMILAR, 1 MG | | Q5150 | INJECTION, AFLIBERCEPT-MRBB (AHZANTIVE), BIOSIMILAR, 1 MG | | Q5151 | INJECTION, ECULIZUMAB-AAGH (EPYSQLI), BIOSIMILAR, 2 MG | | Q5152 | INJECTION, ECULIZUMAB-AEEB (BKEMV), BIOSIMILAR, 2 MG | Discontinued Codes External Breast Prostheses | Code | Narrative | | L8010 | BREAST PROSTHESIS, MASTECTOMY SLEEVE | Miscellaneous | Code | Narrative | | J1094 | INJECTION, DEXAMETHASONE ACETATE, 1 MG | | J1300 | INJECTION, ECULIZUMAB, 10 MG | | J1810 | INJECTION, DROPERIDOL AND FENTANYL CITRATE, UP TO 2 ML AMPULE | | J1890 | INJECTION, CEPHALOTHIN SODIUM, UP TO 1 GRAM | | J1940 | INJECTION, FUROSEMIDE, UP TO 20 MG | | J9037 | INJECTION, BELANTAMAB MAFODOTIN-BLMF, 0.5 MG | | J9247 | INJECTION, MELPHALAN FLUFENAMIDE, 1MG | | Q5139 | INJECTION, ECULIZUMAB-AEEB (BKEMV), BIOSIMILAR, 10 MG | Narrative Changes Bowel Management Devices | Code | Old Narrative | New Narrative | | A4453 | RECTAL CATHETER FOR USE WITH THE MANUAL PUMP-OPERATED ENEMA SYSTEM, REPLACEMENT ONLY | RECTAL CATHETER WITH OR WITHOUT BALLOON, FOR USE WITH ANY TYPE TRANSANAL IRRIGATION SYSTEM, EACH | | A4459 | MANUAL PUMP-OPERATED ENEMA SYSTEM, INCLUDES BALLOON, CATHETER AND ALL ACCESSORIES, REUSABLE, ANY TYPE | MANUAL TRANSANAL IRRIGATION SYSTEM, INCLUDES WATER RESERVOIR, PUMP, TUBING, AND ACCESSORIES, WITHOUT CATHETER, ANY TYPE | Ankle-Foot/Knee-Ankle-Foot Orthoses | Code | Old Narrative | New Narrative | | L1932 | AFO, RIGID ANTERIOR TIBIAL SECTION, TOTAL CARBON FIBER OR EQUAL MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | ANKLE FOOT ORTHOSIS, RIGID ANTERIOR TIBIAL SECTION, TOTAL CARBON FIBER OR EQUAL MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE | | L1951 | ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE), PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE), PLASTIC OR OTHER MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE | | L1971 | ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, WITH OR WITHOUT DORSIFLEXION ASSIST, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | Wheelchair Options/Accessories and Wheelchair Seating | Code | Old Narrative | New Narrative | | E1028 | WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING HARDWARE FOR JOYSTICK, OTHER CONTROL INTERFACE OR POSITIONING ACCESSORY | WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING HARDWARE, OTHER | Miscellaneous | Code | Old Narrative | New Narrative | | A6549 | GRADIENT COMPRESSION GARMENT, NOT OTHERWISE SPECIFIED | GRADIENT COMPRESSION GARMENT, NOT OTHERWISE SPECIFIED, FOR DAYTIME USE, EACH | | A6583 | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, BELOW KNEE, 30-50 MMHG, EACH | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, BELOW KNEE, EACH | | A6585 | GRADIENT PRESSURE WRAP WITH ADJUSTABLE STRAPS, ABOVE KNEE, EACH | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, ABOVE KNEE, EACH | | A6586 | GRADIENT PRESSURE WRAP WITH ADJUSTABLE STRAPS, FULL LEG, EACH | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, ABOVE KNEE, EACH | | A6587 | GRADIENT PRESSURE WRAP WITH ADJUSTABLE STRAPS, FOOT, EACH | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, FOOT, EACH | | A6588 | GRADIENT PRESSURE WRAP WITH ADJUSTABLE STRAPS, ARM, EACH | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, ARM, EACH | | E1801 | STATIC PROGRESSIVE STRETCH ELBOW DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES | STATIC PROGRESSIVE STRETCH/PATIENT ACTUALIZED SERIAL STRETCH ELBOW DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES | | E1811 | STATIC PROGRESSIVE STRETCH KNEE DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES | STATIC PROGRESSIVE STRETCH/PATIENT ACTUALIZED SERIAL STRETCH KNEE DEVICE, EXTENSION AND/OR FLEXION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES | | E1816 | STATIC PROGRESSIVE STRETCH ANKLE DEVICE, FLEXION AND/OR EXTENSION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES | STATIC PROGRESSIVE STRETCH/PATIENT ACTUALIZED SERIAL STRETCH ANKLE DEVICE, FLEXION AND/OR EXTENSION, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES | | E1818 | STATIC PROGRESSIVE STRETCH FOREARM PRONATION / SUPINATION DEVICE, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES | STATIC PROGRESSIVE STRETCH/PATIENT ACTUALIZED SERIAL STRETCH FOREARM PRONATION / SUPINATION DEVICE, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES | | E1841 | STATIC PROGRESSIVE STRETCH SHOULDER DEVICE, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES | STATIC PROGRESSIVE STRETCH/PATIENT ACTUALIZED SERIAL STRETCH SHOULDER DEVICE, WITH OR WITHOUT RANGE OF MOTION ADJUSTMENT, INCLUDES ALL COMPONENTS AND ACCESSORIES | | J9073 | INJECTION, CYCLOPHOSPHAMIDE (INGENUS), 5 MG | INJECTION, CYCLOPHOSPHAMIDE (DR. REDDY'S), 5 MG | | L6692 | UPPER EXTREMITY ADDITION, SILICONE GEL INSERT OR EQUAL, EACH | UPPER EXTREMITY ADDITION, SILICONE GEL INSERT OR EQUAL, WITH OR WITHOUT LOCKING MECHANISM, EACH | | L6698 | ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, LOCK MECHANISM, EXCLUDES SOCKET INSERT | ADDITION TO UPPER EXTREMITY PROSTHESIS, LOCK MECHANISM, EXCLUDES SOCKET INSERT | For questions about correct coding or products not listed on the DMECS Product Classification List (PCL), contact the Pricing, Data Analysis and Coding (PDAC) HCPCS Helpline at (877) 735-1326 during the hours of 9:30 a.m. to 5:00 p.m. ET, Monday through Friday. You may also visit the PDAC website to chat with a representative or select the Contact Us button at the top of the PDAC website for email, FAX, or postal mail information. Publication History | March 27, 2025 | Originally Published | |
