How to use HCPCS code?
Asked by: Fay Bednar | Last update: September 24, 2025Score: 4.1/5 (73 votes)
What is an example of a HCPCS code?
Often pronounced by its acronym as "hick picks," HCPCS is a set of health care procedure codes. Examples: G0008 Administration of influenza virus vaccine.
What is the main purpose of HCPCS codes?
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.
What is the difference between a HCPCS and CPT code?
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.
Do HCPCS codes always start with a letter?
While Level I codes are almost always numeric, Level II codes always begin with single alphabetical character, ranging from A to V, followed by four numbers. In coding and policy discussions the term HCPCS is typically used in reference to Level II codes, while Level I codes are referred to as CPT codes.
HCPCS Level II Coding: Demystifying Services, Supplies, and Modifiers
How do I use HCPCS codes?
Coders use HCPCS codes much like they would ICD or CPT codes. Upon receiving a medical report, you'd take notes on which procedure was performed, which products were prescribed, injected, or otherwise delivered to the patient, and then you'd use your HCPCS code set to find the appropriate code.
How to read CPT code?
- Evaluation and Management: 99201 – 99499.
- Anesthesia: 00100 – 01999; 99100 – 99140.
- Surgery: 10021 – 69990.
- Radiology: 70010 – 79999.
- Pathology and Laboratory: 80047 – 89398.
- Medicine: 90281 – 99199; 99500 – 99607.
Are Hcpcs codes still used?
National HCPCS Level II codes are maintained by CMS, but all private and public health insurers may use them.
What do HCPCS Level I codes begin with?
HCPCS Level I: Current Procedural Technology (CPT) five digit numeric coding system developed by the American Medical Association (AMA). For therapy providers these codes begin with 97XXX and are referred to as the 97000 codes that describe each billable service performed.
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.
Who assigns HCPCS codes?
The Pricing, Data Analysis and Coding (PDAC) contractor with input from the DME MACs are responsible for assigning individual DMEPOS products to HCPCS code categories for billing Medicare. Manufacturers and other entities do not have similar authority to assign their own code determinations to specific products.
What is the last step in the coding process?
The 'four-step coding process' is the method used by clinical coders to ensure accurate and consistent code assignment. As the name suggests, there are four important steps to follow to ensure you arrive at the correct diagnosis or procedure code. Step 1: Analyse, Step 2: Locate, Step 3: Assign, Step 4: Verify.
What type of code is 99211?
Code 99211 is commonly used for services such as patient education, simple rechecks and medication reviews. Some procedures can also appropriately be reported with this code.
Is HCPCS a diagnosis code?
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 is the CPT code 90837?
For CPT code 90837 (psychotherapy, 60 minutes with patient), a physician or other qualified health care professional can report a prolonged service code if the psychotherapy service, not performed with an E/M service, is 90 minutes or longer involving direct patient contact.
What is CPT code 99214?
According to CPT, 99214 is indicated for an “office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history, a detailed examination and medical decision making of moderate complexity.” [For more detailed ...
What is the difference between CPT code and HCPCS code?
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.
Do all HCPCS codes start with a letter?
HCPCS Level II codes are alpha-numeric codes because they consist of a single alphabetical letter followed by four numeric digits, while CPT® codes primarily are identified using five numeric digits. The development and use of HCPCS Level II codes began in the 1980s.
What is the use of HCPCS?
HCPCS is a collection of standardized codes that represent medical procedures, supplies, products and services. The codes are used to facilitate the processing of health insurance claims by Medicare and other insurers. HCPCS is divided into two subsystems, Level I and Level II.
What are some examples of HCPCS codes?
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.
Does Medicare prefer CPT or 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.
What are the two main coding systems?
Two common medical coding classification systems are in use — the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT).
How to use the CPT coding manual?
You'll start at the index & then use that information to go to the tabular section to verify the code (this is called “mapping”). Guidelines for CPT codes are section-specific. These guidelines could be directly before a series of codes, or at the beginning of the section.
Why were HCPCS codes created?
HCPCS codes were developed to simplify medical billing. Standardized coding is necessary to ensure that claims processing proceeds in an orderly and uniform fashion. HCPCS codes are used by public and private health plans.
In what order do you list CPT codes?
For CPT codes, you always want the most intensive procedure to be listed first and then followed by the ones that are not as intense.