HCPCS Codes

About HCPCS Codes.
According to CMS statistics. Each year, in the United States, health care insurers process over 5 billion claims for payment. For Medicare and other health insurance programs to ensure that these claims are processed in an orderly and consistent manner, standardized coding systems are essential. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA. Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.

In October of 2003, the Secretary of HHS delegated authority under the HIPAA legislation to CMS to maintain and distribute HCPCS Level II Codes. As stated in 42 CFR Sec. 414.40 (a) CMS establishes uniform national definitions of services, codes to represent services, and payment modifiers to the codes. Within CMS there is a CMS HCPCS Workgroup which is an internal workgroup comprised of representatives of the major components of CMS, as well as other consultants from pertinent Federal agencies. Prior to December 31, 2003, Level III HCPCS were developed and used by Medicaid State agencies, Medicare contractors, and private insurers in their specific programs or local areas of jurisdiction. For purposes of Medicare, level III codes were also referred to as local codes. Local codes were established when an insurer preferred that suppliers use a local code to identify a service, for which there is no level I or level II code, rather than use a "miscellaneous or not otherwise classified code." The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required CMS to adopt standards for coding systems that are used for reporting health care transactions. We published, in the Federal Register on August 17, 2000 (65 FR 50312), regulations to implement this part of the HIPAA legislation. These regulations provided for the elimination of level III local codes by October 2002, at which time, the level I and level II code sets could be used. The elimination of local codes was postponed, as a result of section 532(a) of BIPA, which continued the use of local codes through December 31, 2003.

HCPCS Coding Process
The regulation that CMS published on August 17, 2000 (45 CFR 162.10002) to implement the HIPAA requirement for standardized coding systems established the HCPCS level II codes as the standardized coding system for describing and identifying health care equipment and supplies in health care transactions that are not identified by the HCPCS level I, CPT codes. The HCPCS level II coding system was selected as the standardized coding system because of its wide acceptance among both public and private insurers. Public and private insurers were required to be in compliance with the August 2000 regulation by October 1, 2002. The HCPCS Level II Coding Process/Criteria document describes HCPCS level II coding procedures and coding criteria, HCPCS Lookup and Search is done by external services.

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980s. Level II codes are also referred to as alphanumeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.

HCPCS Coding classification
Like CPT codes, National codes are composed of five digits. Unlike CPT codes, HCPCS are alphanumeric. An alphanumeric code combines letters of the alphabet with numbers. In the National codes, one alpha letter is followed by four numbers.

Example: A4550 – Surgical tray

The code numbers are split more generally than those of the CPT. For example, codes starting with these alpha characters are:

A – Ambulance services and general supplies
D – Dental services
J – Injections (medication codes)
W, X, Y and Z are reserved for Local cod

Full HCPCS Codes index is:

• 0:0****
• 1:1****
• 2:2****
• 3:3****
• 4:4****
• 5:5****
• 6:6****
• 7:7****
• 8:8****
• 9:9****
• A:Transportation Services Including Ambulance [A0021 - A0999]; Medical and Surgical Supplies [A4206 - A7527]; Administrative, Miscellaneous and Investigational [A9150 - A9999]
• B:Enteral and Parenteral Therapy [B4034 - B9999]
• C:Outpatient PPS [C1010 - C9725]
• D:Dental Procedures
• E:Durable Medical Equipment (DME) [E0100 - E8002]
• F:F HCPCS codes
• G:Procedures and Professional Services [G0001 - G9130]
• H:Alcohol and Drug Abuse Treatment Services [H0001 - H2037]
• J:Drugs Administered Other than Oral Method [J0120 - J8499]; Chemotherapy Drugs [J8501 - J9999]
• K:Temporary Codes [K0001 - K0732]
• L:Orthotic Procedures [L0100 - L4398]; Prosthetic Procedures [L5000 - L9900]
• M:Medical Services [M0064 - M0301]
• N:N HCPCS codes
• P:Pathology and Laboratory Services [P2028 - P9615]
• Q:Miscellaneous Services and Temporary Codes [Q0035 - Q9964]
• R:Diagnostic Radiology Services [R0070 - R0076]
• S:Temporary National Codes (non-Medicare) [S0009 - S9999]
• T:National T Codes Established for State Medicaid Agencies [T1000 - T5999]
• U:U HCPCS codes
• V:Vision, Hearing, and Speech-Language Pathology Services and Devices [V2020 - V2799]

HCPCS Codes Lookup
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