2025 HCPCS Code Update - October Edition - Correct Coding

Joint DME MAC and PDAC Publication

The following tables identify changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for October 2025. The tables contain only HCPCS codes applicable to items within Medicare DME MAC jurisdiction. There may be other HCPCS code changes for items under the jurisdiction of other Medicare contractors. Consult those contractors for information regarding HCPCS codes within their areas of responsibility.

All HCPCS code changes are effective for claims with dates of service on or after October 1, 2025.

Code Change Categories

  • Added Codes/Modifiers: Identifies newly created codes and modifiers. Listing of a code in the tables does not necessarily indicate coverage. Refer to the applicable Local Coverage Determination for information regarding Medicare reimbursement requirements.
  • Discontinued Codes/Deleted Modifiers: Identifies codes and modifiers discontinued or deleted in the new cycle. These codes and modifiers continue to be valid for Medicare claims with dates of service either on or before September 30, 2025. There is no grace period for submission of a discontinued code/modifier for claims with dates of service after its effective end date. If there is a direct crosswalk for a discontinued/deleted code or modifier, the crosswalk code will be displayed in a table.
  • Narrative Changes: Identifies changes in the narrative descriptor for an existing code or modifier.

Added Codes

Lower Limb Prostheses

Code Narrative
L5657 ADDITION TO LOWER EXTREMITY PROSTHESIS, MANUAL/AUTOMATED ADJUSTABLE AIR, FLUID, GEL OR EQUAL SOCKET INSERT FOR LIMB VOLUME MANAGEMENT, ANY MATERIALS

Walkers

Code Narrative
E0150 COMBINATION WHEELED WALKER WITH SEAT AND TRANSPORT CHAIR, FOLDING, ADJUSTABLE OR FIXED HEIGHT

Miscellaneous

Code Narrative
A4288 VALVE FOR BREAST PUMP, REPLACEMENT
E0658 SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, INTEGRATED, 2 FULL ARMS AND CHEST
E0659 SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, INTEGRATED, HEAD, NECK AND CHEST
J0163 INJECTION, EPINEPHRINE IN SODIUM CHLORIDE (ENDO), 0.1 MG
J0164 INJECTION, EPINEPHRINE IN SODIUM CHLORIDE (BAXTER), 0.1 MG
J0458 INJECTION, AZTREONAM/AVIBACTAM, 7.5 MG/2.5 MG (10 MG)
J0462 INJECTION, ATROPINE SULFATE, NOT THERAPEUTICALLY EQUIVALENT TO J0461, 0.01 MG
J0525 INJECTION, CEFOTETAN DISODIUM, 10 MG
J0582 INJECTION, BIVALIRUDIN (ENDO), NOT THERAPEUTICALLY EQUIVALENT TO J0583, 1 MG
J0614 INJECTION, TREOSULFAN, 50 MG
J0668 INSTILLATION, BUPIVACAINE AND MELOXICAM, 1 MG/0.03 MG
J0675 INJECTION, CARBOPROST TROMETHAMINE, 0.1 MG
J0681 INJECTION, CEFTOBIPROLE MEDOCARIL SODIUM, 3 MG
J0738 INJECTION, LENACAPAVIR, 1 MG, FDA APPROVED PRESCRIPTION, ONLY FOR USE AS HIV PRE-EXPOSURE PROPHYLAXIS (NOT FOR USE AS TREATMENT FOR HIV)
J0752 ORAL, LENACAPAVIR, 300 MG, FDA APPROVED PRESCRIPTION, ONLY FOR USE AS HIV PRE-EXPOSURE PROPHYLAXIS (NOT FOR USE AS TREATMENT FOR HIV)

Miscellaneous

Code Narrative
J0579 INJECTION, CLEVIDIPINE BUTYRATE, 1 MG
J1370 INJECTION, ESOMEPRAZOLE SODIUM, 1 MG
J1612 INJECTION, GLUCAGON (GVOKE), 0.01 MG
J1807 INJECTION, ETHACRYNATE SODIUM, 1 MG
J1809 INJECTION, FOSDENOPTERIN, 0.1 MG
J1834 INJECTION, ISONIAZID, 1 MG
J2151 INJECTION, MANNITOL, 250 MG
J2291 INJECTION, NAFCILLIN SODIUM (BAXTER), 20 MG
J3290 INJECTION, TRANEXAMIC ACID, 5 MG
J3402 INJECTION, REMESTEMCEL-L-RKND, PER THERAPEUTIC DOSE
J9011 INJECTION, DATOPOTAMAB DERUXTECAN-DLNK, 1 MG
L1007 SCOLIOSIS ORTHOSIS, SAGITTAL-CORONAL CONTROL PROVIDED BY A RIGID LATERAL FRAME, EXTENDS FROM AXILLA, TO TROCHANTER, INCLUDES ALL ACCESSORY PADS, STRAPS, AND INTERFACE, CUSTOM FABRICATED
L6034 PARTIAL HAND, FINGER, AND THUMB PROSTHESIS WITHOUT PROSTHETIC DIGIT(S)/THUMB, AMPUTATION AT DISTAL TO METACARPAL JOINT, INCLUDING FLEXIBLE OR NON-FLEXIBLE INTERFACE, MOLDED TO PATIENT MODEL, FOR USE WITHOUT EXTERNAL POWER AND/OR PASSIVE PROSTHETIC DIGIT/THUMB, NOT INCLUDING INSERTS DESCRIBED BY L6692
L6035 SINGLE PROSTHETIC DIGIT, MECHANICAL, CAN INCLUDE METACARPOPHALANGEAL (MCP), PROXIMAL INTERPHALANGEAL (PIP), AND/OR DISTAL INTERPHALANGEAL (DIP) JOINT(S), WITH OR WITHOUT LOCKING MECHANISM, CAN INCLUDE FLEXION OR EXTENSION ASSIST, ANY MATERIAL, ATTACHMENT, INITIAL ISSUE OR REPLACEMENT
L6036 PROSTHETIC THUMB, MECHANICAL, CAN INCLUDE METACARPOPHALANGEAL (MCP), INTERPHALANGEAL (IP) JOINT(S), WITH OR WITHOUT LOCKING MECHANISM, CAN INCLUDE FLEXION OR EXTENSION ASSIST, ANY MATERIAL, ATTACHMENT, INITIAL ISSUE OR REPLACEMENT
L6038 ADDITION TO SINGLE PROSTHETIC DIGIT OR THUMB, MECHANICAL, ATTACHMENT, MULTIAXIAL AND/OR INTERNAL/EXTERNAL ROTATION/ABDUCTION/ADDUCTION MECHANISM, WITH OR WITHOUT LOCKING FEATURE, ANY MATERIAL
L6039 PASSIVE PROSTHETIC DIGIT OR THUMB PROSTHESIS NOT INCLUDING HAND RESTORATION PARTIAL HAND, FULL OR PARTIAL, CUSTOM MADE, ANY MATERIAL, INITIAL OR REPLACEMENT, PER SINGLE PASSIVE PROSTHETIC DIGIT OR THUMB

Miscellaneous

Code Narrative
Q5155 INJECTION, AFLIBERCEPT-JBVF (YESAFILI), BIOSIMILAR, 1 MG
Q5156 INJECTION, TOCILIZUMAB-ANOH (AVTOZMA), BIOSIMILAR, 1 MG

Discontinued Codes

Miscellaneous

Code Narrative
J2150 INJECTION, MANNITOL, 25% IN 50 ML
J2503 INJECTION, PEGAPTANIB SODIUM, 0.3 MG

Narrative Changes

Lower Limb Prostheses

Code Old Narrative New Narrative
L5673 ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH LOCKING MECHANISM ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC, OR EQUAL, WITH OR WITHOUT PERFORATIONS, WITH OR WITHOUT BREATHABLE MATERIAL, FOR USE WITH LOCKING MECHANISM

Lower Limb Prostheses

Code Old Narrative New Narrative
L5679 ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR EQUAL, NOT FOR USE WITH LOCKING MECHANISM ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC, OR EQUAL, WITH OR WITHOUT PERFORATIONS, WITH OR WITHOUT BREATHABLE MATERIAL, NOT FOR USE WITH LOCKING MECHANISM
L5783 ADDITION TO LOWER EXTREMITY, USER ADJUSTABLE, MECHANICAL, RESIDUAL LIMB VOLUME MANAGEMENT SYSTEM ADDITION TO LOWER EXTREMITY, USER ADJUSTABLE, MECHANICAL, RESIDUAL LIMB VOLUME MANAGEMENT SYSTEM (WITH OR WITHOUT LAMINATION KIT)

Power Mobility Devices

Code Old Narrative New Narrative
E0986 MANUAL WHEELCHAIR ACCESSORY, PUSH-RIM ACTIVATED POWER ASSIST SYSTEM MANUAL WHEELCHAIR ACCESSORY, POWER ASSIST SYSTEM

Miscellaneous

Code Old Narrative New Narrative
E0765 FDA APPROVED NERVE STIMULATOR, WITH REPLACEABLE BATTERIES, FOR TREATMENT OF NAUSEA AND VOMITING FDA APPROVED NERVE STIMULATOR, FOR TREATMENT OF NAUSEA AND VOMITING
J1961 INJECTION, LENACAPAVIR, 1 MG INJECTION, LENACAPAVIR (ONLY FOR USE AS HIV TREATMENT), 1 MG

Miscellaneous

Code Old Narrative New Narrative
J9072 INJECTION, CYCLOPHOSPHAMIDE (AVYXA), 5 MG INJECTION, CYCLOPHOSPHAMIDE (FRINDOVYX), 5 MG
J9333 INJECTION, ROZANOLIXIZUMAB-NOLI, 1 MG INJECTION, ROZANOLIXIZUMAB-NOLI, 1 MG
L6028 PARTIAL HAND INCLUDING FINGERS, FLEXIBLE OR NON-FLEXIBLE INTERFACE, ENDOSKELETAL SYSTEM, MOLDED TO PATIENT MODEL, FOR USE WITHOUT EXTERNAL POWER, NOT INCLUDING INSERTS DESCRIBED BY L6692 PARTIAL HAND, FINGER, AND THUMB PROSTHESIS WITHOUT PROSTHETIC DIGIT(S)/THUMB, AMPUTATION AT METACARPAL LEVEL, INCLUDING FLEXIBLE OR NON-FLEXIBLE INTERFACE, MOLDED TO PATIENT MODEL, INCLUDING PALM, FOR USE WITHOUT EXTERNAL POWER AND/OR PASSIVE PROSTHETIC DIGIT/THUMB, NOT INCLUDING INSERTS DESCRIBED BY L6692
L7406 ADDITION TO UPPER EXTREMITY, USER ADJUSTABLE, MECHANICAL, RESIDUAL LIMB VOLUME MANAGEMENT SYSTEM ADDITION TO UPPER EXTREMITY PROSTHESIS, USER ADJUSTABLE, MECHANICAL, RESIDUAL LIMB VOLUME MANAGEMENT SYSTEM (WITH OR WITHOUT LAMINATION KIT)

For questions about correct coding or products not listed on the DMECS Product Classification List (PCL), contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 a.m. to 5:00 p.m. ET, Monday through Friday. You may also visit the PDAC website to chat with a representative or select the Contact Us button at the top of the PDAC website for email, FAX, or postal mail information.

Publication History

Date of Change Description
09/25/25 Published on PDAC Website
Last Updated Sep 25 , 2025