Staying Compliant: A Deep Dive into CMS Q4 2025 HCPCS Code Changes

On August 21, 2025, the Centers for Medicare & Medicaid Services (CMS) released its fourth quarter update to the HCPCS Level II code set. This update impacts a wide range of healthcare providers who report services, supplies, drugs, and equipment. It’s essential to review these changes carefully so that your claims remain compliant and are reimbursed correctly when the updates take effect on October 1, 2025.

CMS updates are not just administrative changes—they directly impact your revenue cycle, compliance, and operational workflows. Failing to adopt these changes in time can lead to increased denials, delayed payments, and even audits. Below is an overview of what’s new, what’s changing, and what you need to do to stay ahead.

Key Highlights of the Q4 2025 CMS HCPCS Update

The Q4 2025 update includes:

• 76 new HCPCS Level II codes
• 2 codes with coverage and descriptor changes
• 8 discontinued codes
• 10 codes with revised long descriptors
• 2 codes with updated payment rates
• 1 reactivated code (J0570)
• 1 code with a short descriptor change (J9333)

While the overall number of changes is relatively manageable, some additions are critical for providers working with new drugs, prosthetics, and advanced supply items.

New HCPCS Level II Codes: What’s Been Added?

CMS has introduced codes across several categories, reflecting ongoing advancements in pharmaceuticals, medical devices, and patient care.

Medical & Surgical Supplies

• A2036–A2039: Supplies for wound management.
• A4288: Replacement valve for breast pumps.
• A9612: Fluorescein injections.
• A9616: Radiopharmaceutical drug gallium ga-68 gozetotide.

C Codes (Hospital Outpatient Use)

• C1740–C1742: Various surgical and procedural supplies.
• C8006: Insertion of a pleural-peritoneal shunt.
• C9305–C9306: Injection codes for new therapies.

Durable Medical Equipment (E Codes)

• E0150: Combination wheeled walker with seat.
• E0658–E0659: Pneumatic compression appliances.

Drugs & Biologics (J Codes)

26 new J codes, including:

• J0458: Aztreonam-avibactam (EMBLAVEO™) – indicated for adults with complicated intra-abdominal infections.
• J0752: Oral lenacapavir, 300 mg – approved for HIV pre-exposure prophylaxis (PrEP).
• J0738: Injectable lenacapavir (PrEP use).
• J1961: Revised to specify use for HIV treatment only (SUNLENCA®).

These additions highlight CMS’s recognition of evolving treatment protocols, especially in infectious diseases and oncology.

Prosthetics & Orthotics (L Codes)

Seven new codes for prosthetic devices and orthoses, including:

• L1007: Scoliosis orthosis with sagittal-coronal control, custom fabricated.

Other Categories

• 4 new M codes: For intravenous infusions.
• 23 new Q codes, including Q4390 (Ascendion™) – a minimally manipulated, dehydrated human amniotic membrane allograft.

Revised and Discontinued Codes: What’s Changing?

In addition to new codes, CMS has made several key adjustments:

Coverage & Descriptor Changes:

• E0765 and L6028: Updated coverage and descriptors.

Descriptor-Only Changes:

• C1739: Tissue marker description updated for greater specificity.

Payment Adjustments:

• A4453 and A4459: Revised payment amounts.

Discontinued Codes:

C9088, C9174, C9175, C9248, E0716, J2150, J2503, and S0074 are deleted.

Replacements:

• C9174 → J9011 (Injection, datopotamab deruxtecan-dlnk, 1 mg).
• C9175 → J0614 (Injection, treosulfan, 50 mg).

These revisions reflect CMS’s ongoing efforts to align codes with updated clinical practices and FDA approvals.

How to Prepare for the October 1, 2025, Effective Date

To avoid compliance risks and claim denials, consider these best practices:

• Update Your EHR/Practice Management Software: Ensure all new, revised, and deleted codes are integrated into your system before the effective date.
• Educate Your Billing Team: Conduct training sessions for coders and billers on the new codes, their appropriate use, and coverage nuances.
• Audit Current Claims: Identify services that may fall under the updated codes to avoid retroactive billing errors.
• Review Payer Guidelines: Some commercial payers may adopt CMS changes differently; verify coverage policies.
• Monitor Compliance Metrics: Track denial rates closely in Q4 to catch coding-related errors early.

Why These Updates Matter for Your Revenue Cycle

Accurate HCPCS coding is essential for:

• Preventing claim rejections and payment delays.
• Ensuring compliance with federal regulations.
• Capturing appropriate reimbursement for advanced therapies and supplies.

Given the ongoing complexity of HCPCS updates, many practices find it beneficial to partner with experienced medical billing and coding specialists. Outsourcing can help ensure coding accuracy, continuous compliance with CMS changes, and a more streamlined revenue cycle.

Final Takeaway

The CMS Q4 2025 HCPCS Level II updates may seem minor in volume, but their impact can be significant—especially for providers dealing with specialty drugs, prosthetics, and new supply categories. By proactively preparing and educating your team, you can ensure a smooth transition and safeguard your revenue.

Struggling With Coding Accuracy? Partner With a Coding Expert

Keeping up with quarterly CMS updates, payer-specific requirements, and evolving compliance regulations can be overwhelming for in-house teams. Even minor coding errors can result in claim denials, revenue loss, and audit risks.

That’s where partnering with an experienced medical coding company makes all the difference. Our certified coding specialists stay up to date with every CMS and payer change, ensuring your claims are coded accurately and submitted compliantly the first time.

We Provide:

• Comprehensive coding audits and compliance reviews to minimize denials and mitigate audit risks.
• Expertise across multiple specialties and payer rules, including HCPCS, CPT®, and ICD-10 coding.
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• Dedicated support to boost your coding accuracy and accelerate reimbursements.

By outsourcing your coding needs to us, your team can focus on patient care while we ensure your revenue cycle is optimized and fully compliant.

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