The Centers for Medicare and Medicaid Services (CMS) has established a new HCPCS C-code to signify that the surgically inserted or implanted device (including single use medical devices) was not furnished with the device-intensive procedure. HCPCS code C1890, No implantable/insertable device used with device-intensive procedures, would be reported in the Ambulatory Surgical Center (ASC), and would not be reported on institutional claims by hospital outpatient department providers.
New HCPCS modifier ‘ER’
Hospitals are now required to report HCPCS modifier ER, (Items and services furnished by a provider-based off-campus emergency department) on every claim line that contains a CPT/HCPCS code for an outpatient hospital service provided in an off-campus provider-based emergency department. Modifier ER would be reported on the UB-04 form (CMS Form 1450) for hospital outpatient services. Please note, Critical Access Hospitals (CAHs) would not be required to report this modifier.
Modifier ER is required to be reported in provider-based off-campus emergency departments that meet the definition of a “dedicated emergency department” as defined in 42 Code of Federal Regulations (CFR) 489.24 under the Emergency Medical Treatment and Labor Act (EMTALA) regulations. Per 42 CFR 489.24, a “dedicated emergency department” means any department or facility of the hospital, regardless of whether it is located on or off the main hospital campus. Additional information regarding the definition of a dedicated emergency department can be found in Transmittal 4255, Change Request (CR) 11216, dated March 15, 2019.
Inpatient-Only list changes for Calendar Year (CY) 2019
CMS will remove four procedures and add one procedure from the Inpatient-Only list. These changes are effective for the 2019 calendar year. The procedures that were removed or added are listed in the table below.
|CY 2019 CPT Code||CY 2019 Long Descriptor||Action|
|31241||Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery||Removed|
|01402||Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty||Removed|
|0266T||Implantation or replacement of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programming, and repositioning, when performed).||Removed|
|00670||Anesthesia for extensive spine and spinal cord procedures (e.g., spinal instrumentation or vascular procedures)||Removed|
|C9606||Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel||Added|