About HCPCS Medical Coding (2024)

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About HCPCS Medical Coding? ›

HCPCS (HCPCS - Healthcare Common Procedure Coding System) - Synopsis. The Healthcare Common Procedure Coding System (HCPCS) is produced by the Centers for Medicare and Medicaid Services (CMS). HCPCS is a collection of standardized codes that represent medical procedures, supplies, products and services.

CPT codes are used to report medical, surgical, and diagnostic services performed by healthcare professionals. HCPCS codes are used to report medical procedures and services to Medicare, Medicaid, and other health insurance programs.

First, they ensure that medical procedures and services are accurately and consistently described across the healthcare industry. This helps to reduce errors and misunderstandings that can lead to billing mistakes and other problems. Second, HCPCS codes are used to determine reimbursem*nt rates for healthcare services.

ICD-10-CM diagnosis codes provide the reason for seeking health care; ICD-10-PCS procedure codes tell what inpatient treatment and services the patient got; CPT (HCPCS Level I) codes describe outpatient services and procedures; and providers generally use HCPCS (Level II) codes for equipment, drugs, and supplies for ...

An example of an HCPCS Level I is 90716, which coders can use to denote the administration of varicella or chickenpox vaccine. Meanwhile, an example of an HCPCS Level II code is R0070.

HCPCS Level II: A standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT® codes, such as ambulance services or durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.

In the United States, there are three main coding systems: the International Classification of Diseases (ICD), the Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS).

Today, the CPT coding system is the preferred system for coding and describing healthcare services and procedures in federal programs (Medicare and Medicaid) and throughout the United States by private insurers and providers of healthcare services.

HCPCS Level I consists of the Current Procedural Terminology (CPT)^® code set and is used to submit medical claims to payers for procedures and services performed by physicians, non-physician practitioners, hospitals, laboratories, and outpatient facilities.

Who uses HCPCS codes? ›

HCPCS is used by physicians and other health care professionals and insurance programs.

Providers/suppliers shall not report CPT codes 76937, 76942, 76998, 93318, or other ultrasound procedural codes if the ultrasound procedure is Page 15 Revision Date (Medicare): 5/1/2022 XI-15 performed for guidance during one of these procedures. (CPT code 76001 was deleted January 1, 2019.)

HCPCS modifiers allow for greater accuracy in coding and can be extremely important in the reimbursem*nt process.

Level I HCPCS codes are also known as CPT-4 (Edition 4) codes, while Level II are used to identify products, supplies, and services not included in the CPT standardized coding system, primarily for Medicare and Medicaid. HCPCS codes are owned in the public domain created by Centers for Medicare and Medicaid Services.

Today, the CPT coding system is the preferred system for coding and describing healthcare services and procedures in federal programs (Medicare and Medicaid) and throughout the United States by private insurers and providers of healthcare services.

HCPCS is divided into two principal subsystems, referred to as Level I and Level II of the HCPCS. HCPCS Level I codes are part of the Current Procedural Terminology (CPT®) code set maintained by the CPT® Editorial Panel and copyrighted by the American Medical Association (AMA).

J-codes consist of a letter followed by four numbers, representing specific medications and their dosages within the HCPCS. Physicians pair J-codes with standardized Current Procedural Terminology (CPT) codes when prescribing medication.