Understanding Healthcare Common Procedure Coding System (HCPCS)

In the United States, healthcare insurers process over 5 billion claims annually for payment. To ensure orderly and consistent processing of these claims, standardized coding systems like HCPCS are essential. HCPCS is divided into two main subsystems — Level I and Level II.

HCPCS Level I: Current Procedural Terminology (CPT®)

HCPCS Level I consists of the Current Procedural Terminology (CPT®), a numeric coding system maintained by the American Medical Association (AMA). CPT® codes are used primarily to identify medical services and procedures provided by physicians and healthcare professionals for billing purposes. Key points about CPT® include:

• CPT® codes consist of 5 numeric digits.
• The AMA annually updates and republishes CPT® codes.
• For issues related to the application of HCPCS Level I CPT® codes, healthcare professionals can contact the AMA directly.

HCPCS Level II: Alpha-Numeric Codes

HCPCS Level II is a standardized coding system used to identify products, supplies, and services not covered by CPT® codes, such as ambulance services or durable medical equipment (DMEPOS) outside a physician’s office. Key points about HCPCS Level II include:

• Level II codes consist of a single alphabetical letter followed by 4 numeric digits (alpha-numeric).
• CMS maintains HCPCS Level II codes, deciding on additions, revisions, and deletions.
• The HCPCS Level II coding system was established in the 1980s.
• In 2003, CMS was delegated authority under 42 CFR 414.40(a) to maintain uniform national definitions and payment modifiers for HCPCS Level II codes.

Importance of HCPCS

HCPCS enables Medicare and other health insurers to cover a wide range of services, supplies, and equipment not identified by CPT® codes. This system facilitates accurate billing and reimbursement processes across the healthcare industry.

For questions or further information about HCPCS Level II, contact at info@medvisecorp.com .

Understanding HCPCS is crucial for healthcare providers and insurers alike, ensuring effective management of claims and reimbursement while maintaining consistency in coding practices.