Modifier and HCPCS Changes for April 2026 - JE Part B
Modifier and HCPCS Changes for April 2026
The following new and deleted National Level II modifiers and Healthcare Common Procedure Coding System (HCPCS) are effective for dates of service on/after April 1, 2026.
In compliance with the Health Insurance Portability and Accountability Act (HIPAA), CMS eliminated the 3-month grace period for discontinued codes in Change Request (CR) 3093 dated February 6, 2004. Effective for dates of services on/after January 1, 2010, there is no grace period for billing discontinued HCPCS codes.
NOTE: The inclusion of modifiers or codes on this web page do not necessarily indicate coverage. New modifiers and HCPCS identified as Durable Medical Equipment (DME) are not included in this listing.
New Modifiers
There are no new modifiers being implemented.
New Codes
New Modifiers
There are no new modifiers being implemented.
New Codes
| HCPCS | DESCRIPTION |
|---|---|
| A2040 | Microlyte painguard, per square centimeter |
| A2041 | Foundation drs+ duo, per square centimeter |
| A2042 | Foundation drs+ solo, per square centimeter |
| A2043 | Biobrane, per square centimeter |
| A2044 | Biobrane glove, each |
| A2045 | Novashield or novogen wound matrix, per square centimeter |
| A4318 | Female external urinary collection cup, with or without ring attachment, per day |
| C1743 | Scaffold, endovascular non-coronary, resorbable drug eluting, with delivery system (implantable) |
| C8007 | Open implantation of hypoglossal nerve neurostimulator array and pulse generator, not requiring insertion of a separate distal respiratory sensor electrode or electrode array |
| C8008 | Revision or replacement of hypoglossal nerve neurostimulator array including connection to existing pulse generator |
| C8009 | Removal of hypoglossal nerve neurostimulator array and pulse generator |
| C8010 | Percutaneous placement of permanent common carotid embolic protection device, including all system components and imaging guidance; bilateral |
| C8011 | Open implantation of hypoglossal nerve(s) neurostimulator electrode array(s) and receiver, including external power source and all system components |
| C8012 | Revision or replacement of hypoglossal nerve(s) neurostimulator electrode array(s) and receiver |
| C8013 | Removal of hypoglossal nerve(s) neurostimulator electrode array(s) and receiver |
| C9309 | Injection, onasemnogene abeparvovec-brve, per treatment |
| C9818 | Suzetrigine, oral, 1 mg |
| G0680 | Detection and quantification of coronary artery calcium and/or aortic valve calcification from algorithmic analysis of computed tomography of the chest with report |
| G0681 | Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute for a wound surface area up to 100 sq cm; first 25 sq cm or less of wound surface area |
| G0682 | Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute for a wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure) |
| G0683 | Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute graft for a wound surface greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children |
| G0684 | Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute graft for a wound surface greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) |
| J0463 | Injection, atropine sulfate (fresenius and therapeutically equivalent), 0.01 mg |
| J1098 | Articaine ophthalmic, 8% solution, 0.4 ml |
| J1164 | Injection, diltiazem hydrochloride in 0.72% sodium chloride, 0.5 mg |
| J1553 | Injection, immune globulin (yimmugo), 100 mg |
| J3404 | Injection, zopapogene imadenovec-drba suspension, per therapeutic dose |
| J8502 | Injection, aprepitant (aponvie), 1 mg |
| J9003 | Leuprolide injectable (camcevi etm), 1 mg |
| J9183 | Gemcitabine intravesical system, 225 mg |
| J9277 | Injection, pembrolizumab, 1 mg and berahyaluronidase alfa-pmph |
| J9278 | Injection, carboplatin (avyxa), 1 mg |
| J9601 | Injection, linvoseltamab-gcpt, 1 mg |
| M0233 | Intravenous infusion, tocilizumab-aazg, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose |
| M0234 | Intravenous infusion, tocilizumab-aazg, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose |
| Q0238 | Injection, tocilizumab-aazg, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg |
| Q4418 | Biolab membrane wrap flow, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4419 | Biolab membrane wrap lite flow, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4421 | Biolab membrane wrap solo, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4422 | A/c wrap, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4423 | Biolab tri-membrane wrap flow, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4424 | Revive ft, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4425 | Revive tl, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4426 | Dermabind tl + or dermabind tl x, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4427 | Dermabind dl n or dermabind dl + or dermabind dl x, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4428 | Dermabind sl n or dermabind sl + or dermabind sl x, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4429 | Dermabind ch n or dermabind ch x, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4435 | Renati membrane, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4436 | Renati ac membrane, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4437 | Revival ac, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4438 | Pretect, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4439 | Instagraft, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4440 | Curamatrix, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q5161 | Injection, denosumab-kyqq (aukelso/bosaya), biosimilar, 1 mg |
| Q5162 | Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mg |
| 0614U | Inborn error of metabolism (primary mitochondrial disease), mitochondrial analysis of 4 enzyme complexes by stained blue native polyacrylamide gel electrophoresis (page), frozen tissue (muscle, liver, heart, cultured skin fibroblasts), diagnostic qualitative result |
| 0615U | Borrelia burgdorferi (lyme disease), antibody detection of 26 recombinant protein groups, by immunoassay, igm |
| 0616U | Neurology (dementia), dna methylation analysis of more than 30,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0617U | Cardiovascular (atherosclerotic cardiovascular disease [ascvd]), dna methylation analysis of more than 20,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0618U | Psychiatry (bipolar disorder), dna methylation analysis of more than 10,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0619U | Pulmonary (chronic obstructive pulmonary disease [copd]), dna methylation analysis of more than 18,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0620U | Oncology (hepatocellular carcinoma), dna methylation analysis of more than 5,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0621U | Infectious disease (lyme borreliosis), dna methylation analysis of more than 10,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0622U | Psychiatry (major depressive disorder), dna methylation analysis of more than 20,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0623U | Autoimmune (multiple sclerosis), dna methylation analysis of more than 5,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0624U | Hepatology (nonalcoholic steatohepatitis [nash]), dna methylation analysis of 5,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0625U | Endocrinology (osteoporosis), dna methylation analysis of more than 5,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0626U | Neurology (parkinson disease), dna methylation analysis of more than 20,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0627U | Psychiatry (schizophrenia), dna methylation analysis of more than 15,000 sites, whole blood, algorithm reported as positive or negative risk |
| 0628U | Nephrology (kidney diseaserelated genetic conditions), genomic analysis, renal disease panel, saliva, dna, next-generation sequencing of 449 genes, reported as pathogenic or likely pathogenic variants of uncertain significance or risk alleles |
| 0629U | Infectious disease (tuberculosis), dna, analysis of 1 target by pcr with clustered regularly interspaced short palindromic repeat (crispr)-based probe detection, plasma or serum, qualitative report as detected or not detected |
| 0630U | Oncology (breast), mrna, gene expression profiling by microarray of 80 genes (80 content and 465 housekeeping), utilizing formalin-fixed paraffinembedded tissue (ffpe), algorithm reported as an index that is diagnostic of a molecular subtype (luminal, basal, her2) |
Deleted Codes
| HCPCS | DESCRIPTION |
|---|---|
HCPCS |
DESCRIPTION |
| C9145 | Injection, aprepitant, (aponvie), 1 mg |
| C9307 | Injection, linvoseltamab-gcpt, 1 mg |
| C9308 | Injection, carboplatin (avyxa), 1 mg |
| L6000 | Partial hand, thumb remaining |
| L6010 | Partial hand, little and/or ring finger remaining |
| L6020 | Partial hand, no finger remaining |
Source
Transmittal 13489, CR 14248 dated December 5, 2025
Last Updated Mar 26 , 2026
