Are HCPCS and CPT codes interchangeable?
Asked by: Prof. Fred Hauck I | Last update: July 28, 2025Score: 5/5 (71 votes)
Are HCPCS and CPT codes the same?
Key Differences between HCPCS and CPT
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.
Can CPT and HCPCS be billed together?
Each edit table contains edits which are pairs of HCPCS/CPT codes that in general should not be reported together. Each edit has a Column One and Column Two HCPCS/CPT code. If a provider/supplier reports the 2 codes of an edit pair, the Column Two code is denied, and the Column One code is eligible for payment.
Can HCPCS modifiers be used with CPT codes?
The HCPCS modifier –LT, for example, is regularly used in CPT codes when you need to describe a bilateral procedure that was only performed on one side of the body. HCPCS modifiers, like CPT modifiers, are always two characters, and are added to the end of a HCPCS or CPT code with a hyphen.
Are the coding steps for HCPCS almost identical to those for CPT codes?
Coding for HCPCS is almost identical to coding for CPT because both manuals have an Alphabetic Index and a Tabular List. After searching the Alphabetic Index, the coder turns to the appropriate codes in the Tabular List to perform the final coding steps.
The Difference Between HCPCS and CPT Codes
How does HCPCS differ from ICD-10 and CPT codes?
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 ...
What are used to alter a CPT or HCPCS code?
A medical coding modifier is two characters (letters or numbers) appended to a CPT® or HCPCS Level II code. The modifier provides additional information about the medical procedure, service, or supply involved without changing the meaning of the code.
Is modifier 25 a CPT code or HCPCS?
Modifier 25 – this Modifier is used to report an Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified health care professional.
When a CPT and an HCPCS code exist for the same service one should use the CPT code?
When a CPT® code and HCPCS Level II code exist for the same service or procedure, Medicare frequently requires reporting of the HCPCS Level II code. Several third-party payers follow Medicare guidelines, but medical coders must always check individual payers for their requirements.
When listing both CPT and HCPCS modifiers on a claim?
Final answer: In most cases, the CPT modifier should be listed first when both CPT and HCPCS modifiers are used on a claim. This is because it provides significant information about the procedure performed and additionally affects the amount of reimbursement received.
Are Hcpcs codes only for outpatient?
The Healthcare Common Procedure Coding System (HCPCS) is used to report hospital outpatient procedures and physician services. These coding systems serve an important function for physician reimbursement, hospital payments, quality review, benchmarking measurement and the collection of general medical statistical data.
Can you bill 99213 and 99396 together?
In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.
What is a 58 modifier used for?
Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.
Is HCPCS only for Medicare?
Coders today use HCPCS codes to represent medical procedures to Medicare, Medicaid, and several other third-party payers. The code set is divided into three levels. Level one is identical to CPT, though technically those codes, when used to bill Medicare or Medicaid, are HCPCS codes.
Are CPT codes universal?
The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency.
What CPT codes are deleted for 2024?
Existing codes 99441-99443 will be deleted. For additional information, refer to Appendices P and T in the CPT 2024 code book. The following E/M codes have been revised in the CPT 2024 code set.
Is there a difference between CPT and HCPCS codes?
Some CPT codes are even used internationally. Medical providers often use these codes to describe and document the services they offer, in addition to using them for billing purposes. On the other hand, HCPCS codes are used to bill for a much smaller, more specific range of medical services.
Can 99213 and G0444 be billed together?
G0444 bundles with 99213, however a modifier is allowed if appropriate.
How do CPT ICD-10 and HCPCS codes work together in the medical field?
CPT, ICD-10, and HCPCS codes are essential tools for healthcare providers to ensure accurate coding for billing purposes. By using all three types of codes, healthcare providers and insurance companies can benefit from improved accuracy and reduced costs associated with coding errors.
Are CPT codes included in HCPCS?
HCPCS is divided into 2 main subsystems — Level I and Level II. HCPCS Level I: Comprised of Current Procedural Terminology (CPT®), a numeric coding system maintained by the American Medical Association (AMA).
When not to use modifier 25?
Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.
Do HCPCS codes need modifiers?
HCPCS modifiers
These modifiers provide additional data about medical services, procedures, or supplies without changing the code meanings. Medical coders and healthcare providers use these modifiers to explain what happened during a particular encounter.
What are the three categories of CPT codes?
- Evaluation and management codes describe services such as office visits, consultations, and procedures performed in a physician's office or other outpatient setting.
- Surgery codes describe surgical procedures performed in a hospital or other outpatient setting.
What does HCPCS stand for?
The Healthcare Common Procedure Coding System (HCPCS) is a national, uniform coding structure developed by the Centers for Medicare & Medicaid Services (CMS) to standardize the coding systems used to process Medicare and Medicaid (Medi-Cal) claims on a national basis.
Does CPT require a modifier?
According to CPT, the situations when the use of a modifier may be appropriate are: The service or procedure has both professional and technical components. More than one provider performed the service or procedure. More than one location was involved.