The Healthcare Common Procedure Coding System (HCPCS) is a set of codes used by healthcare providers to describe services, supplies, and equipment for billing purposes. HCPCS is divided into two levels: Level I (CPT codes) and Level II (national codes, such as durable medical equipment, drugs, and services not covered by CPT).

The following 2025 HCPCS updates include new, revised, and deleted codes, along with key changes to the Level II HCPCS codes. These changes apply to a variety of services, including durable medical equipment (DME), pharmaceuticals, vaccines, and telemedicine services.

1. New HCPCS Codes for 2025

Durable Medical Equipment (DME)

• E9999 – Unclassified durable medical equipment: This new code has been added for items that don’t fit into existing categories and must be reported as unclassified DME.

Drugs and Biologicals

• J9212 – Injection, erythropoiesis-stimulating agent, 1 unit (new code for erythropoiesis-stimulating agents used in chronic kidney disease treatments).
• J7305 – Injection, levonorgestrel, for intrauterine contraception (new code for intrauterine devices).

Telemedicine Services

• G2211 – Telehealth consultations, 30 minutes or less (new code for telemedicine consultations under 30 minutes, including behavioral health).

Vaccines

• Q2035 – COVID-19 vaccine, bivalent (updated and clarified for new formulations of COVID-19 vaccines, including boosters).

Clinical Laboratory Services

• G0392 – Genetic testing, hereditary cancer panels (new code for comprehensive genetic testing panels for hereditary cancer syndromes).

2. Revised HCPCS Codes for 2025

Durable Medical Equipment (DME)

• E0431 – Portable oxygen concentrator: Revised to include expanded coverage for portable oxygen concentrators used for long-term oxygen therapy, reflecting updated usage guidelines.

Drugs and Biologicals

• J3380 – Injection, methylprednisolone acetate, 40 mg (updated code for methylprednisolone, includes guidance on dosage forms).
• J3490 – Unclassified drug (revised to include clarification on “unclassified drug” definition for use with experimental medications).

Clinical Laboratory Services

• G0147 – Blood glucose monitoring, with interpretation, for diabetes management (revised to include additional clarification on frequency limits and patient eligibility).

Telemedicine Services

• G0410 – Remote monitoring of cardiovascular devices, less than 30 minutes (revised to include clearer guidelines for device eligibility and documentation requirements).

Vaccines

• Q2032 – Influenza vaccine (trivalent), for high-risk patients (revised to reflect new formulations and updated administration rules).

3. Deleted HCPCS Codes for 2025

Durable Medical Equipment (DME)

• E0200 – Walkers, standard: Deleted due to limited use and consolidation into a broader “walker” code.

Drugs and Biologicals

• J0223 – Injection, hydrocortisone acetate, 5 mg (deleted due to low utilization and shift to more generic formulations).

Clinical Laboratory Services

• G0105 – Prostate cancer screening, PSA and digital exam (deleted due to reimbursement changes and transition to other coding systems for screening).

Telemedicine Services

• G2208 – Telemedicine behavioral health consultations, over 60 minutes (deleted as this consultation duration will now be reported under revised codes).

4. Important HCPCS Code Updates for 2025

Telemedicine and Remote Monitoring

• G2211 – Telehealth Consultation, 30 minutes or less: New code to account for the growing use of telemedicine in mental health, primary care, and other specialties, offering simplified billing for consultations under 30 minutes.
• G0423 – Remote monitoring, home use of cardiovascular devices: Expanded to include more devices and ensure reimbursement for at-home monitoring.

AMA Guidelines:

• Ensure clear documentation for telemedicine services, including the medium used for delivery (video, phone, etc.) and patient consent.
• Time-based codes (e.g., G2211) require accurate documentation of the service duration.

Vaccines and Immunizations

• Q2035 – COVID-19 vaccine, bivalent: Updated and restructured to capture the ongoing adjustments in the COVID-19 vaccination protocols, including bivalent booster shots and adjusted formulations.

AMA Guidelines:

• For vaccines, document the exact formulation and administration route.
• Ensure that the vaccine given aligns with the current CDC recommendations for dosage and population.

Durable Medical Equipment (DME)

• E0431 – Portable oxygen concentrators (revised): Expanded to align with the growing use of portable oxygen devices in home care settings. Clarifies eligibility criteria and coverage for patients requiring oxygen therapy on a long-term basis.

AMA Guidelines:

• For DME codes, ensure that medical necessity is clearly documented (e.g., justification for use of portable oxygen concentrators, including patient’s oxygen saturation levels).

Genetic Testing & Laboratory Services

• G0392 – Genetic testing, hereditary cancer panels (new): This expanded code enables billing for a broad range of genetic tests used for diagnosing hereditary cancer syndromes. The inclusion of next-generation sequencing in this update provides more comprehensive coverage for cancer testing.

AMA Guidelines:

• Ensure that the clinical indications for genetic testing are documented, including the family history of cancer and specific genes being tested.
• Follow updated payer requirements for genetic testing, which may include pre-authorization.

5. HCPCS Modifiers for 2025

Modifiers are used to adjust or clarify the service provided, and it’s important to use them appropriately for accurate billing. Key HCPCS modifier updates for 2025 include:

• Modifier KX – Used to indicate that the patient meets the medical necessity requirements for high-cost durable medical equipment.
• Modifier JZ – Used to indicate that an unclassified drug (J3490) was administered, with supporting documentation provided.
• Modifier 76 – Repeat procedure or service by the same provider (updated to clarify documentation for repeated tests).
• Modifier 77 – Repeat procedure or service by a different provider (updated with additional guidelines on documentation for non-duplicate services).
• Modifier 59 – Distinct procedural service (updated to ensure clarity in telemedicine encounters and remote monitoring billing).