I 

114TH CONGRESS 

1ST SESSION H. R. 3291 

To amend title XVIII of the Social Security Act to develop a crosswalk 

between HCPCS and MS–DRG codes for similar hospital services. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 29, 2015 

Mr. RYAN of Wisconsin introduced the following bill; which was referred to 

the Committee on Ways and Means, and in addition to the Committee 

on Energy and Commerce, for a period to be subsequently determined by 

the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to develop 

a crosswalk between HCPCS and MS–DRG codes for 

similar hospital services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Crosswalk 

5 Hospital Code Development Act of 2015’’. 


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1 SEC. 2. DEVELOPMENT OF MEDICARE HCPCS VERSION OF 

2 MS–DRG CODES FOR SIMILAR HOSPITAL 

3 SERVICES. 

4 Section 1886 of the Social Security Act (42 U.S.C. 

5 1395ww) is amended by adding at the end the following 

6 new subsection: 

7 ‘‘(t) RELATING SIMILAR INPATIENT AND OUT8 PATIENT HOSPITAL SERVICES.— 

9 ‘‘(1) DEVELOPMENT OF HCPCS VERSION OF

10 MS–DRG CODES.— 

11 ‘‘(A) IN GENERAL.—Not later than Janu12 ary 1, 2018, the Secretary shall develop 

13 HCPCS versions for MS–DRGs that is similar 

14 to the ICD–10–PCS for such MS–DRGs such 

15 that, to the extent possible, the MS–DRG as16 signment shall be similar for a claim coded with 

17 the HCPCS version as an identical claim coded 

18 with an ICD–10–PCS code. 

19 ‘‘(B) COVERAGE OF SURGICAL MS–DRGS.— 

20 In carrying out subparagraph (A), the Sec21 retary shall develop HCPCS versions of MS– 

22 DRG codes for not fewer than 10 surgical MS– 

23 DRGs. 

24 ‘‘(C) PUBLICATION AND DISSEMINATION

25 OF THE HCPCS VERSIONS OF MS–DRGS.— 


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1 ‘‘(i) IN GENERAL.—The Secretary 

2 shall develop an HCPCS MS–DRG defini3 tions manual and software that is similar 

4 to the definitions manual and software for 

5 ICD–10–PCS codes for such MS–DRGs. 

6 The Secretary shall post the HCPCS MS– 

7 DRG definitions manual and software on 

8 the Internet website of the Centers for 

9 Medicare & Medicaid Services. The 

10 HCPCS MS–DRG definitions manual and 

11 software shall be in the public domain and 

12 available for use and redistribution without 

13 charge. 

14 ‘‘(ii) USE OF PREVIOUS ANALYSIS

15 DONE BY MEDPAC.—In developing the 

16 HCPCS MS–DRG definitions manual and 

17 software under clause (i), the Secretary 

18 shall consult with the Medicare Payment 

19 Advisory Commission and shall consider 

20 the analysis done by such Commission in 

21 translating outpatient surgical claims into 

22 inpatient surgical MS–DRGs in preparing 

23 chapter 7 (relating to hospital short-stay 

24 policy issues) of its ‘Medicare and the 


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1 Health Care Delivery System’ report sub2 mitted to Congress in June 2015. 

3 ‘‘(D) DEFINITION AND REFERENCE.—In 

4 this paragraph: 

5 ‘‘(i) HCPCS.—The term ‘HCPCS’ 

6 means, with respect to hospital services 

7 (other than inpatient hospital services) for 

8 which payment is made under this title, 

9 the code under the Healthcare Common 

10 Procedure Coding System (HCPCS) (or a 

11 successor code) for such services. 

12 ‘‘(ii) ICD–10–PCS.—A reference to 

13 an ICD–10–PCS code includes a reference 

14 to a successor to such code.’’. 

Æ 


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