2023 CPT changes for Oncology

New Prostatectomy Code 

First, CPT adds a new code for laparoscopic prostatectomy that joins the existing surgical codes addressing the prostate. 

When a physician uses robotic assistance to remove the prostate, use 55867 (Laparoscopy, surgical prostatectomy, simple subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy), includes robotic assistance, when performed). 

Check out New Lab Codes

You’ll also find several new lab codes that reflect tests performed on patients with cancer or those who are being tested for cancerous conditions:

• 81441 (Inherited bone marrow failure syndromes (IBMFS) (eg, Fanconi anemia, dyskeratosis congenita, Diamond-Blackfan anemia, Shwachman-Diamond syndrome, GATA2 deficiency syndrome, congenital amegakaryocytic thrombocytopenia) sequence analysis panel, must include sequencing of at least 30 genes, including BRCA2, BRIP1, DKC1, FANCA, FANCB, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCL, GATA1, GATA2, MPL, NHP2, NOP10, PALB2, RAD51C, RPL11, RPL35A, RPL5, RPS10, RPS19, RPS24, RPS26, RPS7, SBDS, TERT, and TINF2)

• 81449 (Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; RNA analysis)
• 81451 (Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes (eg, BRAF, CEBPA, DNMT3A, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MLL, NOTCH1, NPM1, NRAS), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis)
• 81456 (Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis)

New Cat III Code

Oncologists will also note that CPT 2023 includes a Category III code, 0739T (Ablation of malignant prostate tissue by magnetic field induction, including all intraprocedural, transperineal needle/catheter placement for nanoparticle installation and intraprocedural temperature monitoring, thermal dosimetry, bladder irrigation, and magnetic field nanoparticle activation). If you ablate malignant prostate tissue using magnetic field induction, you should report this code after Jan. 1.

Remember, category III codes reflect emerging technologies, procedures, services, etc. The more you report this code, the more data on its use will be collected. This code has no assigned Relative Value Unit (RVU) or established payment, meaning the reimbursement is at the payer’s discretion. Be sure to include the operative report, letter of medical necessity, and copy of the U.S. Food and Drug Administration approval letter to help support your claim.

Although this list reflects many of the codes that oncologists will find applicable in 2023, you’re encouraged to read the entire list of CPT changes on the American Medical Association’s website.

New HCPCS Level II Codes

CMS added several new HCPCS Level II codes regarding percutaneous breast biopsies. These codes include:

• C7501 (Percutaneous breast biopsies using stereotactic guidance, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, all lesions unilateral and bilateral (for single lesion biopsy, use appropriate code)) and
• C7502 (Percutaneous breast biopsies using magnetic resonance guidance …)).

You will also see new codes you can report for drugs used to treat certain types of breast cancer:

• J9393 (Injection, fulvestrant (teva) not therapeutically equivalent to j9395, 25 mg) and

• J9394 (Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg).

Additionally, you will gain three new codes to report multiple myeloma treatments, which include:

• J9046 (Injection, bortezomib, (dr. reddy’s), not therapeutically equivalent to j9041, 0.1 mg),
• J9048 (Injection, bortezomib (fresenius kabi), not therapeutically equivalent to j9041, 0.1 mg), and
• J9049 (Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg).

Next, you will see one new code to report a drug used to prevent nausea and vomiting caused by chemotherapy: J1456 (Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg).

In 2023, CMS will also give you a new code, Q5126 (Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg), to report a drug used to treat different types of cancers, including metastatic colorectal cancer, non-small cell lung cancer, glioblastoma, and metastatic renal cell carcinoma.

Finally, you will see several new M-codes to report different types of care patients receive:

• For example, submit M1156 if a patient received active chemotherapy during the measurement period.
• Submit M1157 if the patient received a bone marrow transplant at any time during the measurement period.

• Lastly, submit M1192 if the patient has an existing diagnosis of squamous cell carcinoma of the esophagus.

   

Revised Codes

CMS will also revise HCPCS Level II codes in 2023. For example, you will see changes to G9847 and G9848:

• G9847 (Patient received chemotherapysystemic cancer-directed therapy in the last 14 days of life). Emphasis added.
• G9848 (Patient did not receive chemotherapysystemic cancer-directed therapy in the last 14 days of life). Emphasis added.

As you can see, “chemotherapy” has been removed from both of the above code descriptors, and “systemic cancer-directed therapy” will be used instead.

Some patient referral codes will also see revisions next year. For instance, G9968 (Patient was referred to another provider or specialist during the performance period) will change to (Patient was referred to another clinician or specialist during the measurement period).

Code G9969 will also see revisions: Clinician who referred the patient to another providerclinician received a report from the providerclinician to whom the patient was referred.

For both codes, the word “provider” will change to “clinician” in the descriptor.

2023 Deletions

You will also see several code deletions, meaning you won’t be able to report them in 2023. These deletions include the following:

• G9250 (Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment) and G9251 (Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment)

• G9618 (Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind) and G9620 (Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given)
• M1017 (Patient admitted to palliative care services).