Health Information Management

No more grace period for HCPCS

APCs Insider, August 5, 2004

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QUESTION: I heard that Medicare has eliminated the 90-day grace period for Healthcare Common Procedure Coding Systems (HCPCS) code reporting as of January 1, 2005. Is this true?

ANSWER: Yes, Medicare has eliminated the 90-day grace period for HCPCS code reporting for physicians, hospitals, and suppliers who use HCPCS in billing Medicare carriers, Durable Medical Equipment Regional Carriers (DMERCs), and fiscal intermediaries (FIs).

Effective January 1, 2005, carriers, DMERCs, and FIs will no longer accept discontinued HCPCS codes for dates of service January 1 through March 31 of the current year (beginning in 2005) that are submitted prior to April 1. HCPCS codes must be valid at the time service is rendered or your claims may be returned and not paid. All claims with discontinued CPT or HCPCS Level II codes will be returned to the provider for correction. Transmittal 89 provides these instructions and can be found at

Historically, CPT code books published by the American Medical Association are released in the beginning of October, so securing your book order is crucial. Annual updates to HCPCS codes can be downloaded from CMS's Web site at in October. The HCPCS quarterly updates are also available from this Web site. It is imperative that hospitals structure a plan for encoder, chargemaster, and technology updates as well as facility education.

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