Healthcare Common Procedural Codes (HCPCS) Updates for 2025
Below is an overview highlighting some of the 2025 changes to Healthcare Common Procedural Codes (HCPCS)
There were 167 new HCPCS Level II codes added for 2025, 1 new A code, 19 new C codes, 10 new E codes, 34 new G codes, 2 new H codes, 24 New J codes, 55 new M codes, and 21 Q codes. Additionally, 64 HCPCS codes were discontinued. You can download the file of HCPCS codes effective January 1, 2025 and modifiers at HCPCS Quarterly Update | CMS .
This release goes hand in hand with the Medicare Physician Fee Schedule (MPFS) Final Rule release. This year the 2025 Medicare conversion factor (CF) of $32.35, a decrease of $0.94 or 2.83 percent from the current 2024 CF rate of $33.29. This conversion factor multiplied by the total relative value units applied to a service totals the base payment amount for a given service. A geographic factor is added based on the location where the service is provided. Some of the code changes found in the new HCPCS file were the result of initiatives found in the MPFS Final Rule.
A strong foundational primary care system is fundamental to improving health outcomes, lowering mortality, and reducing health disparities. The Department of Health and Human Services has been taking action to strengthen primary care, by establishing coding and payment for advanced primary care management services in the CY 2025 PFS final rule.
Three new HCPCS G-codes (G0556, G0557, G0558) were added to account for the complexity of caring for patients based on the number of chronic conditions. There are no time-based thresholds included in the service elements, which is intended to reduce the administrative burden associated with current coding and billing.
The addition of HCPCS code G0559, for post-operative care services furnished by a practitioner other than the one who performed the surgical procedure (or another practitioner in the same group practice) was added to combat overlapping billing for postoperative care. This code is intended to capture the circumstance where postoperative care is rendered by a provider who did not perform surgery (and not in the group practice) and failed to initiate a transfer of care for the postoperative window. The patient sees a different provider for pos operative care that is not captured by coding the surgery with modifier 54.
For CY 2025, CMS included a new HCPCS add-on code to describe the intensity and complexity inherent to hospital inpatient or observation care, associated with a confirmed or suspected infectious disease, performed by a practitioner with specialized training in infectious diseases. The new HCPCS add-on code describes service elements, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment.
G0545 Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)
The Not Invisible Act created a Commission that included law enforcement, Tribal leaders, federal partners, service providers, family members of missing or murdered individuals, and survivors. As mandated by the Act, the Commission developed recommendations for federal government actions to take on focused topics to combat violent crime against Indigenous people and within Indian lands, and to address the epidemic of missing people, and the murder or trafficking of American Indian and Alaska Native peoples, as specified under the law. There are 2 new M codes implemented for The Not Invisible Act Commission who recommended the Department of Health & Human Services establish two HCPCS Level II codes to describe supportive services provided to those who are left behind after someone goes missing or is murdered and is an Indigenous persons (MMIP) and for those with a history of Trauma (HT). The CMS Final HCPCS Coding Determination was to establish two new HCPCS Level II codes
H0052 - “Missing and murdered indigenous persons (mmip) mental health and clinical care”
H0053 - “Historical trauma (ht) mental health and clinical care for indigenous persons”
Skin Substitutes saw 8 new additions and no deletions.
In rulemaking over the last few years, CMS finalized multiple policies to implement section 90004 of the Infrastructure Investment and Jobs Act, which established a refund for discarded amounts of certain single-dose container or single-use package drugs under Part B. This year they clarified several policies implemented in the CY 2023 and CY 2024 PFS final rules, including: exclusions of drugs, for which payment has been made under Part B for fewer than 18 months, from the definition of refundable single-dose container or single-use package drug, and identifying single-dose containers. They also finalized the requirement that the JW modifier must be used if a billing supplier is not administering a drug, but there are amounts discarded during the preparation process before supplying the drug to the patient. Additionally, CMS cited skin substitutes will not be included in the identification of refundable drugs for the calendar quarters in 2025.
q3_2024_drugs_or_biologicals_clean_10.30-508.pdf
The following skin substitutes are regulated as a human cell, tissue, or cellular or tissue-based product (HCT/P) solely under section 361 of the Public Health Service (PHS) Act and 21 CFR Part 1271 when intended for use as a “barrier or cover.
Q4346 Shelter dm matrix, per square centimeter
Shelter™ DM Matrix is a dual membrane, minimally manipulated, human amniotic and chorionic membrane product derived from placental tissue that retain the structural and functional characteristics of the tissue. The final product is dehydrated, packaged in different size sheets and terminally sterilized by irradiation. Shelter™ DM Matrix is composed of extracellular matrix proteins and is intended for use over wounds and as a barrier or protective coverage for acute and chronic wounds. The product is typically used for individuals with full thickness acute and chronic wounds where a biologic barrier or wound cover is required. The dosage is per centimeter square, depending on the size of the injury or site of application. Shelter™ DM Matrix is supplied in various sizes.
Q4347 Rampart DL matrix, per square centimeter
Rampart™ DL Matrix is a dual layer, minimally manipulated, human amniotic membrane product derived from placental tissue that retains the structural and functional characteristics of the tissue. The final product is dehydrated, packaged in different size sheets and terminally sterilized by irradiation. Rampart™ DL Matrix is composed of extracellular matrix proteins and is intended for use over wounds and as a barrier or protective coverage for acute and chronic wounds. The product is typically used for individuals with full thickness acute and chronic wounds where a biologic barrier or wound cover is required. The dosage is per centimeter square, depending on the size of the inju
Q4348 Sentry sl matrix, per square centimeter
Sentry™ SL Matrix is a single layer, minimally manipulated, human amniotic membrane product derived from placental tissue that retain the structural and functional characteristics of the tissue. The final product is dehydrated, packaged in different size sheets and terminally sterilized by irradiation. Sentry™ SL Matrix is composed of extracellular matrix proteins and is intended for use over wounds and as a barrier or protective coverage for acute and chronic wounds. The product is typically used for individuals with full thickness acute and chronic wounds where a biologic barrier or wound cover is required. The dosage is per centimeter square, depending on the size of the injury or site of application. Sentry™ SL Matrix is supplied in various sizes.
Q4349 Mantle dl matrix, per square centimeter
Mantle™ DL Matrix is a dual layer, minimally manipulated, human amniotic membrane product derived from placental tissue that retain the structural and functional characteristics of the tissue. The final product is dehydrated, packaged in different size sheets and terminally sterilized by irradiation. Mantle™ DL Matrix is composed of extracellular matrix proteins and is intended for use over wounds and as a barrier or protective coverage for acute and chronic wounds. The product is typically used for individuals with full thickness acute and chronic wounds where a biologic barrier or wound cover is required. The dosage is per centimeter square, depending on the size of the injury or site of application. Mantle™ DL Matrix is supplied in various sizes.
Q4350 Palisade dm matrix, per square centimeter
Palisade™ DM Matrix is a dual membrane, minimally manipulated, human amniotic and chorionic membrane product derived from placental tissue that retain the structural and functional characteristics of the tissue. The final product is dehydrated, packaged in different size sheets and terminally sterilized by irradiation. Palisade™ DM Matrix is composed of extracellular matrix proteins and is intended for use over wounds and as a barrier or protective coverage for acute and chronic wounds. The product is typically used for individuals with full thickness acute and chronic wounds where a biologic barrier or wound cover is required. The dosage is per centimeter square, depending on the size of the injury or site of application. Palisade™ DM Matrix is supplied in various sizes.
Q4351 Enclose tl matrix, per square centimeter
Enclose™ TL Matrix is a tri-layered minimally manipulated human placental membrane product derived from donated placental tissues that retain the structural and functional characteristics of the tissues. The final product is dehydrated, packaged in different size sheets and terminally sterilized by irradiation. Enclose™ TL Matrix is composed of extracellular matrix proteins and serves as a natural, biological barrier or wound cover. The product is typically used for individuals with chronic full thickness ulcers and other skin defects where a biological barrier or cover is required. Enclose™ TL Matrix is used by or on order for a licensed physician for single patient use. The dosage is per centimeter square, depending on the size of the injury or site of application. Enclose™ TL Matrix is supplied in various size and configuration sheets.
Q4352 Overlay sl matrix, per square centimeter
Overlay™ SL Matrix is a single layer, minimally manipulated, human amniotic membrane product derived from placental tissue that retain the structural and functional characteristics of the tissue. The final product is dehydrated, packaged in different size sheets and terminally sterilized by irradiation. Overlay™ SL Matrix is composed of extracellular matrix proteins and is intended for use over wounds and as a barrier or protective coverage for acute and chronic wounds. The product is typically used for individuals with full thickness acute and chronic wounds where a biologic barrier or wound cover is required. The dosage is per centimeter square, depending on the size of the injury or site of application. Overlay™ SL Matrix is supplied in various sizes.
Q4353 Xceed tl matrix, per square centimeter
Xceed™ TL Matrix is derived from processed human placental tissue and consists of three layers of placental membranes. Xceed™ TL Matrix is composed of extracellular matrix proteins and is intended for use over wounds and as a barrier or protective coverage for acute and chronic wounds. Xceed™ TL Matrix is supplied in various sizes.
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