Remove punctuation marks, special chars and space and compare cols
Since you only have 644 rows, you could probably get away (performance-wise) with creating a user defined function.

Create Function [dbo].[RemoveSpecialCharacters](@Temp VarChar(1000))
Returns VarChar(1000)
AS
Begin

    Declare @KeepValues as varchar(50)
    Set @KeepValues = '%[^A-Za-z0-9]%'
    While PatIndex(@KeepValues, @Temp) &gt; 0
        Set @Temp = Stuff(@Temp, PatIndex(@KeepValues, @Temp), 1, '')

    Return @Temp
End




Then, assuming your sample data (I purposely changed a value in the last row.)

DROP TABLE IF EXISTS DESCR_COMP;
go
CREATE TABLE DESCR_COMP (
    HCPCS CHAR(5) NOT NULL
    ,SEQNUM CHAR(4) NOT NULL
    ,NEW_LONG_DESC CHAR(1000) NOT NULL
    ,OLD_LONG_DESC CHAR(1000) NOT NULL
    ,SHORT_DESC CHAR(250) NOT NULL
    ,ADD_DT DATE
    ,ACT_EFF_DT DATE
    ,TERM_DT DATE
    ,CONSTRAINT PK_HCPCS PRIMARY KEY CLUSTERED (HCPCS ASC)
    )
insert into DESCR_COMP select 'A0120', '0010', 'Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems', 'Non-emergency transportation: mini-bus, mountain area transports, or other  transportation systems', 'Noner transport mini-bus', '19820101', '20030101', ''
insert into DESCR_COMP select 'A0130', '0010', 'Non-emergency transportation: wheelchair van', 'Non-emergency transportation: wheel-chair van', 'Noner transport wheelch van', '19820101', '', ''
insert into DESCR_COMP select 'A0170', '0010', 'Transportation ancillary: parking fees, tolls, other', 'Transportation ancillary:  parking fees, tolls, other', 'Transport parking fees/tolls', '19820101', '20030101', ''
insert into DESCR_COMP select 'A0180', '0010', 'Non-emergency transportation: ancillary: lodging-recipient', 'Non-emergency transportation: ancillary:  lodging-recipient', 'Noner transport lodgng recip', '19820101', '', ''
insert into DESCR_COMP select 'A0190', '0010', 'Non-emergency transportation: ancillary: meals-recipient', 'Non-emergency transportation: ancillary:  meals-recipient', 'Noner transport meals recip', '19840101', '', ''
insert into DESCR_COMP select 'A0200', '0010', 'Non-emergency transportation: ancillary: lodging escort', 'Non-emergency transportation: ancillar:  lodging escort', 'Noner transport lodgng escrt', '19820101', '', ''
go




SELECT *
FROM DESCR_COMP
WHERE dbo.RemoveSpecialCharacters(OLD_LONG_DESC) &lt;&gt; dbo.RemoveSpecialCharacters(NEW_LONG_DESC)


Results:

| HCPCS | SEQNUM | NEW_LONG_DESC                                           | OLD_LONG_DESC                                           | SHORT_DESC                   | ADD_DT     | ACT_EFF_DT | TERM_DT    |
|-------|--------|---------------------------------------------------------|---------------------------------------------------------|------------------------------|------------|------------|------------|
| A0200 | 0010   | Non-emergency transportation: ancillary: lodging escort | Non-emergency transportation: ancillar:  lodging escort | Noner transport lodgng escrt | 1982-01-01 | 1900-01-01 | 1900-01-01 |