¾ Once you find the term in the Index, note the recommended code. Code description *PLEASE NOTE: This list applies to participating providers only* All inpatient services require an authorization and they are not included on this list. Page updated: August 2020 . The list includes the code descriptions, payment category (also known as “fee schedule category”—see Chapter 5 of this manual for information), and to find the drug code to cross-reference to the Tabular List. Cross-reference all codes listed, whether it is one code, a series of codes separated by commas, or a code … Part 2 – Medicare Non-Covered Services: HCPCS Codes . Structure and Use of HCPCS Level II Codes The main terms are in boldface type in the index. While every attempt has been made to assure this listing is accurate, Prior authorization required? CPT/HCPCS code. The second column has the HCPCS codes that require an NDC for all other providers, not the OPPS providers. contractor in whose jurisdiction a claim would be filed in order to determine coverage under Medicare. List of HCPCS V Codes. Select a code to see the full description. NOTE: The jurisdiction list includes codes … 2019 HCPCS Codes > V Codes. Start with the main term and review any available subterms. Revision date: 10/16/2020: HCPCS Level II code is more specific and takes precedence over the CPT code. first column on this list has the HCPCS codes that require an NDC for providers submitting outpatient prospective payment system (OPPS) claims. 2019 Jurisdiction List for DMEPOS HCPCS Codes NOTE: Deleted codes are valid for dates of service on or before the date of deletion. REVENUE CODE LIST-CPT-HCPCS For Providers Effective March 15, 2020 . All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, includingCigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service Please refer to the prior authorization list. HCPCS Appendix A Winter 2021 DME MAC Jurisdiction B Supplier Manual Page 1 Level II HCPCS Codes The following is a list of Level II HCPCS codes. Updated list of applicable HCPCS codes for Haegarda (c-1 esterase inhibitor); replaced J3590 with J0599 10/01/2019 Added Fasenra (benralizumab) autoinjector, prefilled syringe labeled for self -administration (HCPCS code J0517) Removed Hemlibra (emicizumab) This section contains five-character HCPCS Level II (national), interim codes, and three or four-character Health Insurance Portability and Accountability Act (HIPAA)-compliant revenue codes used for billing. Main term entries include tests, services, supplies, orthotics, prostheses, medical equipment, drugs, therapies, and some medical and surgical procedures. 2020 Jurisdiction List for DMEPOS HCPCS Codes NOTE: Deleted codes are valid for dates of service on or before the date of deletion. Medicare Non-Covered Services HCPCS Codes. Continued; V2108 Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens V2109 Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens

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