A HCPCS Code Called Temporary Has Not Expired. Check Its Status Before You Change a Claim.

A billing team sees a HCPCS Level II code described as temporary and assumes it has expired. If the team replaces it without checking the date of service and the official code file, a correct claim can be delayed or changed unnecessarily. The label alone does not establish that the code has ended.

In transmittal 13912, CMS clarifies that HCPCS Level II codes are not designated temporary or permanent and remain effective until CMS announces otherwise. The manual update takes effect November 16, 2026. This is a clarification of code maintenance, not a blanket change to coverage or payment.

Check the date of service first

CMS updates HCPCS codes quarterly and distributes added, revised, and deleted codes. The claims processing manual says a prior-year service must be reported using the codes and modifiers in effect during that year. For a claim held across a year-end, the current code list alone is not enough: compare the service date with the appropriate historical file.

For example, if a service was furnished in December and the claim is submitted in January, start with the code valid on the December service date. This is a workflow example, not a statement that a particular code remains valid. Confirm the individual code and any applicable payer instructions before submitting.

Active does not mean covered

A code identifies an item or service; its active status does not by itself establish Medicare coverage, medical necessity, or payment. Check the applicable coverage policy and contractor guidance as well as the code file. The CMS manual states that each state sets its own Medicaid coverage and payment levels, and certain Level II codes are reserved for private insurers. Do not assume one payer follows another payer’s rules.

Four checks for the billing desk

Give one person ownership of the exceptions and keep the source and service date with the review:

• List the Level II codes in use and flag those marked temporary in local charge or edit tables.
• Check each code against the CMS quarterly file for the date of service, including any announced deletion or revision.
• Review Medicare coverage and contractor instructions separately; confirm other payers’ rules with the relevant payer.
• Have a qualified coder resolve mismatches before changing a charge or releasing a held claim, and record the decision.

Find the source of repeated denials

A single claim correction can clear one item, while an outdated local edit can keep generating the same work. Our Free Revenue Review can examine 90 days of denials for one payer to see whether coding-related denials warrant a closer look. We sign a BAA before practice data is shared.