Are you wondering
“How to apply for a HCPCS Code?”
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The Service: We provide end-to-end service to apply for a HCPCS Code for your assets
HOW WE HELP APPLY FOR A HCPCS CODE
- Understand key assets, patient population and corporate priorities
- Develop a complete and comprehensive HCPCS coding applications and CPT Code Change Requests
- Submit the application to CMS or the AMA
- Defend the applications through all phases of the coding process
WHAT TO EXPECT WHEN YOU APPLY FOR A HCPCS CODE
- Complete code change applications for CMS’s HCPCS workgroup and the CPT Editorial Panel
- All supporting materials needed to be successful in obtaining new codes
The Case Study: Apply for a HCPCS code for a Novel Inhaled COPD Treatment
The Situation
Gettysburg Healthcare Consulting was engaged by a by a pharmaceutical company that was commercializing a novel COPD treatment and needed a HCPCS code to describe the drug.
THE ASK
Our client approached us with a clear directive: take full ownership of the HCPCS coding strategy and application process. As they prepared for product launch, their internal team needed to stay focused on other critical commercialization activities—such as distribution planning, provider education, and sales readiness.
They relied on our deep expertise in Medicare coding and reimbursement to independently manage the complex and often opaque HCPCS code submission process. From aligning on the optimal coding pathway to drafting a compelling application and advocating before CMS, we were trusted to drive this effort from start to finish—with minimal oversight.
OUR APPROACH
Market and Product Analysis
We conducted in-depth research into the product and its associated disease state to validate the need for a unique HCPCS code. This included identifying potential regulatory or reimbursement barriers that could impact market access. We developed risk mitigation strategies to simplify the pathway to market
End-to-End HCPCS Code Support
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Developed and submitted a comprehensive HCPCS code application for the drug
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Engaged directly with the CMS HCPCS Workgroup to present, clarify, and advocate for the code
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Coordinated with CMS Durable Medical Equipment Medicare Administrative Contractors (DME MACs) to lay the groundwork for appropriate coverage
The Result
Successful Market Entry Despite Generic Competition
The drug launched in a crowded, highly genericized therapeutic category—and exceeded expectations. Strategic coding and early reimbursement planning helped position the product for rapid uptake and long-term success.
What you need to know when you apply for a HCPCS code with us
Click here to visit our HCPCS toolkit
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Contact us to learn more about how you can apply for a HCPCS code
